NEUPOGEN INJECTION 480MCG/0.8ML 10 X 0.8ML SYR (10 X 0.8 ML SYR) (NDC: 55513020910)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,582.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
HealthPartners Freedom Plan II Standard Rx
|
$7.10 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $4,275.21 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom Plan III StandardRx
|
$14.60 |
$100* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,383.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,491.47 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $4,575.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:14 /30Days | $4,171.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,160.95 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
HealthPartners Classic Plan (HMO)
|
$28.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $4,290.83 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $4,271.42 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,596.92 |
Browse Plan Formulary |
UCare Connect (HMO)
|
$32.60 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,596.92 |
Browse Plan Formulary |
UCare's Minnesota Senior Health Options (H
|
$32.60 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,596.92 |
Browse Plan Formulary |
HumanaChoice H6609-005 (PPO)
|
$36.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,145.94 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica AccessAbility (HMO)
|
$37.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $4,263.78 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $4,131.64 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,270.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,341.15 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,270.02 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,270.02 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,345.39 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,521.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,507.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $4,500.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,325.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,354.72 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
HealthPartners Freedom III Std Plus Rx (Co
|
$52.40 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P Q:11 /21Days | $4,357.15 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,270.02 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $4,270.02 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
MHP North Star Advantage Basic (HMO-POS)
|
$87.90 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | P | $4,637.64 |
Browse Plan Formulary |
HealthPartners Freedom Plan III EnhancedRx
|
$167.50 |
$125* | to be determined | 3* |
Tier 3 |
25% | n/a | None | $4,288.24 |
Browse Plan Formulary |