INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG (500 ML BAG) (NDC: 00338052003)
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 |
Blue Medicare Access Standard (Regional PP
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,068.04 |
Browse Plan Formulary |
Blue Medicare Access Value (Regional PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,068.04 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | None | $1,009.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$9.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$14.50 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-121 (PFFS)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,057.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,057.26 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
4 |
Tier 4 |
$74.00 | $148.00 | None | $1,031.41 |
Browse Plan Formulary |
MediGold Essential Care (HMO)
|
$20.90 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $80.00 | P | $1,015.51 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,031.41 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$21.80 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,031.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,057.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,057.26 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
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 |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
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 |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
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 |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
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 |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,068.66 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | P | $1,042.86 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-129 (PFFS)
|
$22.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-122 (PFFS)
|
$23.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-131 (PFFS)
|
$24.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-132 (PFFS)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-123 (PFFS)
|
$25.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $1,086.61 |
Browse Plan Formulary |
HumanaChoice R5826-007 (Regional PPO)
|
$28.20 |
$0 |
to be determined |
3 |
Tier 3 |
$82.00 | $205.00 | P | $1,026.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-080 (Regional PPO)
|
$30.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,026.90 |
Browse Plan Formulary |
MediGold Network Choice (PPO)
|
$31.20 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $50.00 | P | $1,015.51 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Securex (HMO-POS)
|
$31.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $881.03 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced Ohio (HMO)
|
$34.00 |
$0 |
to be determined |
2 |
Tier 2 |
$32.00 | $80.00 | None | $881.03 |
Browse Plan Formulary |
MediGold Classic Preferred (HMO)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$25.00 | $50.00 | P | $1,015.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $881.03 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced Ohio (PPO)
|
$55.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $881.03 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
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 |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,049.72 |
Browse Plan Formulary |
Advantage Plan Optimumx (HMO-POS)
|
$57.10 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | None | $1,037.12 |
Browse Plan Formulary |