NORVIR 100MG SOFTGEL CAP (NDC: 00074663330)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | None | $3,422.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,259.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,252.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Opt
|
$9.30 |
$0 |
to be determined |
2 |
Tier 2 |
$39.00 | $78.00 | None | $3,249.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,257.12 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
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 |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
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 |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,204.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,259.25 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,193.44 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,193.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,193.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,193.44 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,193.44 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Opt
|
$19.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $70.00 | None | $3,249.89 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
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 |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
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 |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,268.64 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,187.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,473.16 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,473.16 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,473.16 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,473.16 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,242.69 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,206.32 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,206.32 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,206.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,206.32 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,206.32 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.16 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,218.19 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,219.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,223.73 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,220.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,257.12 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,232.95 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,224.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,290.48 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,195.18 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $3,287.06 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | None | $3,138.00 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,208.05 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,208.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $90.00 | None | $3,222.74 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $90.00 | None | $3,222.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,197.72 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,182.75 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$33.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,182.75 |
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 |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | None | $3,171.62 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,198.77 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $3,268.59 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $3,268.59 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $3,268.59 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $3,222.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $3,222.74 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $3,222.74 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $3,222.74 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$43.00 | $129.00 | None | $3,222.74 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,199.81 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,199.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,199.81 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,199.81 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,199.81 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,252.70 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,242.13 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | None | $3,373.91 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.73 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,220.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,239.61 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,279.21 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.65 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,288.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,253.20 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,271.56 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,384.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | None | $3,373.91 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,190.41 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,197.07 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,197.07 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,197.07 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,197.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,254.96 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,195.99 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | None | $3,263.28 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$57.20 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,198.80 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
3 |
Tier 3 |
$60.00 | $150.00 | None | $3,198.80 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,232.95 |
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 |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,224.52 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,290.48 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,195.18 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $75.00 | None | $3,287.06 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$59.60 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $3,198.77 |
Browse Plan Formulary |