KINERET FOR INJECTION 1100MG/0.67ML CRTN (100 MG/0.67 ML CRTN) (NDC: 55513017701)
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 |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Balance Plus (HMO-PO
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AARP MedicareComplete Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,321.45 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,328.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $1,608.41 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $1,608.41 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $1,608.41 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $1,608.41 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:28 /28Days | $1,608.41 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$27.00 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,317.87 |
Browse Plan Formulary |
AmeriChoice Personal Care Plus (HMO)
|
$31.20 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $1,321.45 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Aetna Medicare Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Dual Advantage Plan (HMO)
|
$35.00 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,305.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,328.53 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,343.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:19 /28Days | $1,330.77 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Horizon Medicare Blue Value w/ Rx Std (HMO
|
$40.40 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:84 /84Days | $1,319.22 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,577.69 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,582.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,550.19 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$48.40 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,317.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Horizon Medicare Blue Value w/ Rx Enhanced
|
$66.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:84 /84Days | $1,319.22 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/ Rx Std (HM
|
$67.10 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:84 /84Days | $1,319.22 |
Browse Plan Formulary |
Horizon Medicare Blue Access w/Rx Enhanced
|
$77.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | Q:84 /84Days | $1,319.22 |
Browse Plan Formulary |