RISPERDAL CONSTA 50MG SYR (50 MG VIAL DSPK) (NDC: 50458030811)
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 |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
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 |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$35.00 | $70.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
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 |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$45.00 | $90.00 | None | $517.85 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $527.67 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $527.52 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $532.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $532.11 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
5 |
Tier 5 |
33% | 33% | None | $522.77 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $546.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $527.67 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.58 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.58 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.58 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $90.00 | P | $523.58 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$33.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | Q:1 /14Days | $514.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $527.52 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $532.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $532.11 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $530.59 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:2 /28Days | $529.56 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
5 |
Tier 5 |
25% | 25% | Q:100 /30Days | $533.66 |
Browse Plan Formulary |