QUASENSE 0.15-0.03 TABLET DOSE PACK 3 MONTHS (NDC: 52544096691)
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 |
Advantra Elite (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $207.00 | None | $45.16 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
Bravo Classic (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $46.07 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
FreedomBlue PPO HD Rx (PPO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.67 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $36.19 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.97 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.97 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $12.00 | None | $39.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
FreedomBlue PFFS Choice Plus (PFFS)
|
$14.60 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.69 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SeniorBlue - Option 3 (PPO)
|
$18.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $22.00 | None | $45.05 |
Browse Plan Formulary |
FreedomBlue PPO Basic Rx (PPO)
|
$18.80 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $0.00 | Q:90 /90Days | $36.97 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $0.00 | Q:90 /90Days | $36.97 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 | to be determined | 1 |
Tier 1 |
$9.00 | $18.00 | None | $36.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FreedomBlue PPO Standard (PPO)
|
$21.20 |
$0 | to be determined | 1 |
Tier 1 |
$7.00 | $17.50 | None | $46.67 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $36.97 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $36.97 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $12.00 | Q:91 /91Days | $45.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | None | $35.51 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $45.01 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $46.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $46.07 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$23.70 |
$0 | to be determined | 1 |
Tier 1 |
$4.00 | $8.00 | None | $46.07 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $39.80 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $39.80 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $39.80 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $39.80 |
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 |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $36.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
Advantra Gold (PPO)
|
$29.70 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $210.00 | None | $45.15 |
Browse Plan Formulary |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 | to be determined | 1 |
Tier 1 |
25% | 25% | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 | to be determined | 1 |
Tier 1 |
$8.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $0.00 | Q:90 /90Days | $37.36 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 1 |
Tier 1 |
$10.00 | $20.00 | None | $45.21 |
Browse Plan Formulary |
FreedomBlue PPO Deluxe (PPO)
|
$51.80 |
$0 | to be determined | 1 |
Tier 1 |
$6.00 | $15.00 | None | $46.67 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $12.50 | None | $45.20 |
Browse Plan Formulary |