ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES (30 BLPK CRTN) (NDC: 00555108301)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Advantra Elite (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Elite (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Silver (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Silver (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
UPMC for Life PPO High Deductible with Rx
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $687.62 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
SecurityBlue Basic (HMO)
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.10 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
33% | n/a | S Q:120 /30Days | $618.60 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Geisinger Gold Open 3 $0 Deductible Rx (PF
|
$18.50 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $784.92 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $736.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $664.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $601.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | P Q:360 /90Days | $678.12 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$23.70 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | P Q:120 /30Days | $678.12 |
Browse Plan Formulary |
FreedomBlue PPO Select (PPO)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $684.03 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P Q:4 /1Days | $697.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Secure 2 (HMO)
|
$28.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityBlue Standard (HMO)
|
$28.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $786.25 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $786.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
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 |
Geisinger Gold Classic 1 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
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 |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $786.25 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $786.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 3 Standard Rx (HMO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.19 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $785.92 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
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 |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
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 |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.51 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.51 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.51 |
Browse Plan Formulary |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred Standard Rx (PPO)
|
$29.00 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $787.51 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Advantra Gold (HMO)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $677.63 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
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 |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 1 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $793.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $786.25 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $786.25 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $788.70 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $787.99 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Geisinger Gold Classic 2 $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $779.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
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 |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
Geisinger Gold Preferred $0 Deductible Rx
|
$33.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $15.00 | None | $782.79 |
Browse Plan Formulary |
UPMC for Life HMO Rx (HMO)
|
$33.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life HMO Rx Enhanced (HMO)
|
$34.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
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 |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $654.81 |
Browse Plan Formulary |
FreedomBlue PPO Classic (PPO)
|
$38.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.27 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $629.12 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $627.55 |
Browse Plan Formulary |
SecurityBlue Deluxe (HMO)
|
$46.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
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 |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $625.75 |
Browse Plan Formulary |
FreedomBlue PPO Platinum (PPO)
|
$83.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /25Days | $678.55 |
Browse Plan Formulary |