PROPOXY-N/APAP 100-500MG TABLET (100 TABLETS BOT) (NDC: 50111079001)
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.23 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $210.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-084 (PFFS)
|
$18.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-087 (PFFS)
|
$21.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:240 /30Days | $232.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-085 (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $230.53 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
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 |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-086 (PFFS)
|
$27.10 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $229.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-088 (PFFS)
|
$28.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Humana Gold Choice H2944-089 (PFFS)
|
$29.50 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $100.00 | Q:240 /30Days | $208.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Windsor Medicare Extra Fusion Plan (HMO)
|
$32.00 |
$0 | to be determined | 4 |
Tier 4 |
$45.00 | $135.00 | Q:240 /30Days | $187.61 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |
Humana Gold Choice H1804-128 (PFFS)
|
$32.20 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | Q:240 /30Days | $224.50 |
Browse Plan Formulary |