METOPROLOL TARTRATE INJECTION USP 5MG 10X5ML VIALSD (10 X 5ML VIALSD) (NDC: 55390007310)
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 |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
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 |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Advantra Gold (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $21.12 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P | $22.02 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.82 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.50 | $15.00 | None | $22.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.50 | $15.00 | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.50 | $15.00 | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $22.08 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$4.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $19.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | None | $23.07 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $12.00 | None | $22.54 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $22.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$12.10 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.50 | None | $21.39 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$18.80 |
$310 |
to be determined |
1 |
Tier 1 |
n/a | n/a | None | $22.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-117 (PFFS)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $22.08 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.99 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $20.53 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $22.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
1 |
Tier 1 |
$2.00 | $4.00 | None | $21.97 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
HumanaChoice H5214-009 (PPO)
|
$24.90 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $20.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $20.35 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $20.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $10.00 | None | $20.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-118 (PFFS)
|
$32.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
HumanaChoice R5826-004 (Regional PPO)
|
$33.30 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $0.00 | None | $23.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-077 (Regional PPO)
|
$35.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $23.59 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $24.00 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $23.23 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $210.00 | None | $21.16 |
Browse Plan Formulary |