PEG-INTRON REDIPEN 80MCG 4PK (80 MCG/0.5ML 4PAK CTR) (NDC: 00085131602)
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 Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
AARP MedicareComplete Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,121.42 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Value (PPO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,170.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,170.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,428.14 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$10.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $2,428.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,159.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,159.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,170.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,170.44 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Plus (PPO)
|
$17.70 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
VIVA Medicare Plus Rx Gold (HMO)
|
$17.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $2,134.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-112 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,176.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,176.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $2,200.56 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,176.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,176.94 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,127.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,127.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,127.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,127.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,127.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $2,127.48 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,214.35 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $2,307.14 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-108 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-110 (PFFS)
|
$23.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-109 (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-107 (PFFS)
|
$27.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,108.63 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-111 (PFFS)
|
$27.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,134.70 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$28.50 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,241.37 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Special Needs Plan (PPO)
|
$30.70 |
$310 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Preferred (PPO)
|
$34.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,300.71 |
Browse Plan Formulary |
HumanaChoice R5826-001 (Regional PPO)
|
$36.20 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:4 /28Days | $2,122.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.24 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
HealthSpring HealthyLiving Premier (HMO)
|
$38.90 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,161.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,155.85 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,159.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,159.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,154.07 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:4 /28Days | $2,166.14 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$60.60 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $2,121.65 |
Browse Plan Formulary |