REMODULIN 10MG/ML VIAL (20 VIALMD) (NDC: 66302011001)
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 MedicareComplete Choice (PP
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Unison Advantage Choice (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,383.10 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Open Value Plan w/Rx (PFFS)
|
$0.10 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-099 (PFFS)
|
$17.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
HumanaChoice H6900-004 (PPO)
|
$18.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-101 (PFFS)
|
$19.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$19.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$21.50 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-077 (PFFS)
|
$22.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,948.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,678.30 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-074 (PFFS)
|
$22.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 (PPO)
|
$22.80 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | None | $12,797.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-100 (PFFS)
|
$22.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
SeniorBlue - Option 2 (PPO)
|
$24.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,914.50 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$25.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $12,725.60 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-076 (PFFS)
|
$25.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$27.30 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $12,797.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-081 (Regional PPO)
|
$30.00 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $12,329.70 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$32.10 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $12,725.60 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Unison Advantage Plus (HMO)
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $12,383.10 |
Browse Plan Formulary |
Unison Advantage Plus Integrated Care (HMO
|
$32.10 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | $12,383.10 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Community Living (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,927.30 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life Specialty Plan (HMO)
|
$32.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-075 (PFFS)
|
$34.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
HumanaChoice R5826-002 (Regional PPO)
|
$35.70 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $12,329.70 |
Browse Plan Formulary |
SeniorBlue - Option 1 (PPO)
|
$41.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $10,914.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |
UPMC for Life PPO Rx Enhanced (PPO)
|
$55.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $13,014.50 |
Browse Plan Formulary |