KIONEX POW USP (454 GM BOTPL) (NDC: 00574200416)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,624.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
HealthPartners Freedom Plan II Standard Rx
|
$7.10 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,542.14 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $3,044.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $4,546.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom Plan III StandardRx
|
$14.60 |
$100* |
to be determined |
1* |
Tier 1 |
$9.00 | $18.00 | None | $5,112.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,536.69 |
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 |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $3,756.27 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $5,620.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $4,245.72 |
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 |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $4,085.00 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,114.85 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $5,112.22 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $120.00 | None | $5,629.63 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
CareBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,767.85 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $5,134.01 |
Browse Plan Formulary |
SecureBlue (HMO)
|
$37.50 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,712.01 |
Browse Plan Formulary |
AbilityCare (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,686.13 |
Browse Plan Formulary |
AbilityCare (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,686.13 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $0.00 | None | $4,253.89 |
Browse Plan Formulary |
SeniorCare Complete (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,686.13 |
Browse Plan Formulary |
SeniorCare Complete (HMO)
|
$37.60 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $3,686.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,037.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,517.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,542.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,587.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,543.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
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 |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $4,546.23 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $5,112.22 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 |
to be determined |
1 |
Tier 1 |
$12.00 | $36.00 | None | $1.52 |
Browse Plan Formulary |
HealthPartners Freedom Plan III EnhancedRx
|
$167.50 |
$125* |
to be determined |
1* |
Tier 1 |
$10.00 | $20.00 | None | $5,112.12 |
Browse Plan Formulary |