HECTOROL 4 MCG/2ML AMPUL (NDC: 58468012201)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $1,295.26 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $1,460.71 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,392.38 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,460.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,460.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $1,460.71 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $1,318.89 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Basic w/Standard Rx
|
$38.90 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std Rx -
|
$38.90 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Prime Sol. Enhanced w/Enhanced Rx -
|
$67.90 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,318.89 |
Browse Plan Formulary |