INNOHEP 20000UNIT/ML VIAL (10 X 2 ML VIALMD) (NDC: 67211034253)
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 |
Essence Advantage (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | None | $1,410.94 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | None | $1,410.94 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | None | $1,410.94 |
Browse Plan Formulary |
Essence Advantage Special Needs Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$59.00 | $118.00 | None | $1,410.94 |
Browse Plan Formulary |
Humana Gold Choice H1804-290 (PFFS)
|
$0.00 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,498.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,554.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,503.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,503.37 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,579.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:26 /365Days | $1,593.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:14 /30Days | $1,507.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-063 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,498.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-064 (PFFS)
|
$36.10 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,498.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-061 (PFFS)
|
$38.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-062 (PFFS)
|
$39.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,509.83 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
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 |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
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 |
Humana Gold Choice H2944-060 (PFFS)
|
$40.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Asuris TruAdvantage + Rx Classic (PPO)
|
$42.80 |
$265 |
to be determined |
4 |
Tier 4 |
26% | n/a | None | $1,509.43 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
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 |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-059 (PFFS)
|
$47.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:14 /30Days | $1,516.14 |
Browse Plan Formulary |
Asuris TruAdvantage + Rx Enhanced (PPO)
|
$70.70 |
$0 |
to be determined |
4 |
Tier 4 |
30% | n/a | None | $1,509.43 |
Browse Plan Formulary |