HEPARIN SODIUM INJECTION USP 5000UNITS 25 X 10ML VIALMD (25 X 10 ML VIALMD) (NDC: 63323004710)
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 |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Complete (PPO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | n/a |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred (H
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $384.69 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Preferred Ea
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $399.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-091 (PFFS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $415.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
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 |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $435.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
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 Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
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 Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.54 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.29 |
Browse Plan Formulary |
Plan Name |
Monthly 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 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 58 (
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $411.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.62 |
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
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
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
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.94 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 2 (HMO-POS
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $416.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.97 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$18.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $0.00 | None | $397.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $400.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $398.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $399.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $409.14 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred (HMO)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $180.00 | None | $388.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-093 (PFFS)
|
$28.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-090 (PFFS)
|
$28.40 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,484.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$30.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO)
|
$30.40 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $387.14 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
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 |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $413.89 |
Browse Plan Formulary |
AmeriChoice Secure Plus Complete (HMO)
|
$30.70 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $413.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Choice H2944-092 (PFFS)
|
$32.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,238.93 |
Browse Plan Formulary |
Humana Gold Plus H4461-012 (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,378.15 |
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 |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$35.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$35.90 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Diamond (PPO)
|
$36.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
HumanaChoice H4408-006 (PPO)
|
$36.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,445.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Ruby (PPO)
|
$37.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.57 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Platinum (PFFS)
|
$40.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Sapphire (PPO)
|
$40.50 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
BlueAdvantage Gold (PFFS)
|
$42.40 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $25.00 | None | $1,094.01 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $427.87 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.44 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $435.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $434.99 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$45.70 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $389.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $426.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $430.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $432.04 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H4461-016 (HMO)
|
$55.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | None | $1,225.60 |
Browse Plan Formulary |