FUZEON CONVENIENCE KIT (1 X 60 VIAL CRTN) (NDC: 00004038039)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.25 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,637.59 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,719.28 |
Browse Plan Formulary |
Anthem Senior Advantage Basic (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,719.28 |
Browse Plan Formulary |
Anthem Senior Advantage Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,719.28 |
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 |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,724.37 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,724.37 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,654.64 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$2.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | Q:1 /1Days | $2,719.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,703.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,700.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,800.07 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,800.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,695.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,695.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,699.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,699.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
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 |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
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 |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,638.18 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,703.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,700.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,691.95 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,708.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,708.63 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,657.72 |
Browse Plan Formulary |
MediGold Essential Care (HMO)
|
$20.90 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,665.00 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,800.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,800.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,672.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,708.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,708.63 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,744.81 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,722.96 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,884.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,645.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,633.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,633.09 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$24.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $2,665.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,633.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,633.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-132 (PFFS)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,647.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-123 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,647.79 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,621.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,699.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,699.94 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
|
$28.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,642.59 |
Browse Plan Formulary |
CareSource Advantage (HMO)
|
$30.40 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,738.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H3619-001 (PPO)
|
$30.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:60 /30Days | $2,642.72 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$30.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,665.02 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$30.50 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $2,637.89 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,755.08 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$30.50 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $2,755.08 |
Browse Plan Formulary |
HumanaChoice R5826-080 (Regional PPO)
|
$30.80 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:60 /30Days | $2,642.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediGold Network Choice (PPO)
|
$31.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,665.00 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,266.70 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,266.70 |
Browse Plan Formulary |
MediGold Classic Preferred (HMO)
|
$36.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $2,665.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.52 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,770.33 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,780.57 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $2,749.19 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,695.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,695.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,689.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:1 /30Days | $2,696.22 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,266.70 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $2,266.70 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $2,645.47 |
Browse Plan Formulary |