ORAL TRANSMUCOSAL FENTANYL CITRATE LOZENGES (30 CRTN) (NDC: 00555108401)
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 |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $995.67 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $995.67 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Option 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $995.67 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $995.67 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $995.67 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO-
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $30.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $952.64 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $862.36 |
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 | $991.68 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$13.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $975.89 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$13.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $975.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$16.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $928.65 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$18.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $928.65 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
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
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
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 |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$20.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.87 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-011 (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-012 (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-014 (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
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 | $676.87 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Primary Plan
|
$24.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.63 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | P Q:4 /1Days | $912.63 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
HumanaChoice H5525-004 (PPO)
|
$25.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
HumanaChoice H1418-010 (PPO)
|
$26.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring TotalCare (HMO)
|
$28.30 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-043 (PFFS)
|
$31.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Option 3 (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $878.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-041 (PFFS)
|
$32.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice R5826-009 (Regional PPO)
|
$34.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-040 (PFFS)
|
$34.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $816.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Humana Gold Choice H2944-042 (PFFS)
|
$36.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
HumanaChoice H1418-013 (PPO)
|
$36.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:120 /30Days | $809.35 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $15.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $15.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $15.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $15.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving (HMO-POS)
|
$43.40 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $15.00 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $798.19 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:120 /30Days | $793.70 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
2 |
Tier 2 |
$7.50 | $22.50 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
2 |
Tier 2 |
$7.50 | $22.50 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
2 |
Tier 2 |
$7.50 | $22.50 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
2 |
Tier 2 |
$7.50 | $22.50 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$70.20 |
$0 |
to be determined |
2 |
Tier 2 |
$7.50 | $22.50 | Q:120 /30Days | $872.02 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Alliance Medicare PPO30 Rx Plus (PP
|
$80.00 |
$0 |
to be determined |
1 |
Tier 1 |
$6.00 | $18.00 | P | $1,148.21 |
Browse Plan Formulary |