HECTOROL 2.5MCG CAPSULE (NDC: 58468012101)
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 |
Advantra Platinum PPO (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,077.03 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,077.09 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $210.00 | None | $1,081.00 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.57 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.57 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$44.00 | $110.00 | None | $1,153.27 |
Browse Plan Formulary |
MedicareBlue PPO (Regional PPO)
|
$5.90 |
$310 |
to be determined |
2 |
Tier 2 |
23% | 23% | None | $1,085.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5868-001 (PPO)
|
$8.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.29 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.55 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.55 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,076.43 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $1,075.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,094.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | n/a | S Q:103 /30Days | $1,094.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,091.80 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.40 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.62 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,096.94 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.08 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,069.84 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,095.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,092.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.00 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,093.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | n/a | S Q:103 /30Days | $1,094.27 |
Browse Plan Formulary |