LEXAPRO 20MG TABLET (100 TABLETS BOT) (NDC: 00456202001)
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 |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$45.00 | $90.00 | S | $96.49 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:90 /90Days | $97.12 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (HMO)
|
$7.30 |
$100 | to be determined | 2 |
Tier 2 |
$37.00 | $93.00 | None | $97.09 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $99.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:90 /90Days | $97.11 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$17.60 |
$0 | to be determined | 4 |
Tier 4 |
$78.00 | $156.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$17.80 |
$100 | to be determined | 4 |
Tier 4 |
$68.00 | $136.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | Q:30 /30Days | $102.56 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$22.20 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.75 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.05 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.05 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.05 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $90.00 | Q:90 /90Days | $97.05 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO)
|
$30.20 |
$310 | to be determined | 3 |
Tier 3 |
$47.00 | $94.00 | S | $96.49 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$33.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:90 /90Days | $97.09 |
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 |
Evercare Plan IP (PPO)
|
$33.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $95.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $99.55 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.79 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | Q:30 /30Days | $98.67 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | S Q:1 /1Days | $97.47 |
Browse Plan Formulary |