PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY (24 X 1 ML TRAY) (NDC: 59676032004)
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 (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,265.02 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,249.95 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,249.95 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,266.56 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,266.56 |
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 |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | P | $1,249.95 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,265.02 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,265.02 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,265.02 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,265.02 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,258.02 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,258.02 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,258.02 |
Browse Plan Formulary |
Generations Healthcare Classic powered by
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,295.58 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,264.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,264.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $1,264.66 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,286.46 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.34 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
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 Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Generations Healthcare Premier powered by
|
$9.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,295.58 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,288.13 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,288.13 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,285.32 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$19.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$19.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
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 Advantage 3 powered by CCR
|
$19.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,291.72 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P | $1,333.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.34 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,293.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-023 (PFFS)
|
$24.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.33 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,289.77 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-022 (PFFS)
|
$30.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,226.67 |
Browse Plan Formulary |
HumanaChoice H8644-003 (PPO)
|
$31.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,235.45 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
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 |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
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 |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:14 /30Days | $1,254.17 |
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:12 /28Days | $1,286.46 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
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:12 /28Days | $1,285.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,303.26 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,321.03 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,320.16 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,319.67 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 |
to be determined |
5 |
Tier 5 |
30% | 30% | P | $1,325.54 |
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:12 /28Days | $1,288.13 |
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:12 /28Days | $1,288.13 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,288.23 |
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:12 /28Days | $1,289.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
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:12 /28Days | $1,289.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:12 /28Days | $1,289.20 |
Browse Plan Formulary |