PYLERA 125-125MG CAPSULE (120 BOT) (NDC: 58914060021)
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 |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,081.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,081.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,081.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,081.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,081.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
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 H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,071.17 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,075.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,081.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,082.78 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
3 |
Tier 3 |
$90.00 | $225.00 | None | $1,076.80 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | Q:120 /30Days | $1,039.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,079.88 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.79 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$33.60 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:120 /30Days | $1,077.79 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
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 |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | Q:120 /30Days | $1,077.54 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,089.33 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,076.80 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,086.81 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,100.85 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,080.15 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $175.00 | None | $1,107.08 |
Browse Plan Formulary |