PROCRIT 10000U/ML VIAL (6 X 1 ML VIALSD) (NDC: 59676031001)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,937.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,937.17 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,937.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,937.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:12 /28Days | $1,930.37 |
Browse Plan Formulary |
Avera Advantage Value Plus (PFFS)
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,933.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.48 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $230.00 | P | $1,898.05 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:12 /28Days | $1,936.87 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | P Q:12 /28Days | $1,936.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-015 (PFFS)
|
$16.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,942.47 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,944.13 |
Browse Plan Formulary |
Avera Advantage Premier Plus (PFFS)
|
$21.40 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,933.00 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,874.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,874.04 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,874.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,874.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-016 (PFFS)
|
$21.70 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P Q:14 /30Days | $1,874.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,997.98 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:14 /30Days | $1,891.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:14 /30Days | $1,891.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:14 /30Days | $1,891.52 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:14 /30Days | $1,891.52 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P Q:14 /30Days | $1,891.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.27 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
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 |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
Browse Plan Formulary |
Medica Advantage Solution Choice (PFFS)
|
$29.10 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P Q:12 /28Days | $1,896.94 |
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 |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,897.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,934.25 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Standard Rx
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,901.00 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Std Rx -
|
$38.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,901.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P | $1,978.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,977.89 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,979.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
2 |
Tier 2 |
$36.00 | $72.00 | P | $1,978.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,930.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,936.87 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | P Q:12 /28Days | $1,936.87 |
Browse Plan Formulary |
Medica Prime Sol. Enhanced w/Enhanced Rx -
|
$67.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,901.00 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 |
to be determined |
2 |
Tier 2 |
$34.00 | $68.00 | P Q:12 /28Days | $1,901.00 |
Browse Plan Formulary |