SANDOSTATIN LAR 30MG KIT (1 KIT PKGCOM) (NDC: 00078034261)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | None | $3,648.99 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,485.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,485.58 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,458.24 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,477.06 |
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:1 /28Days | $3,580.18 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | P Q:1 /28Days | $3,478.60 |
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 |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,485.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,345.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,345.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,345.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,345.18 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,345.18 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
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 |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $3,413.03 |
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 |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
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 H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.91 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.75 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,580.18 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,319.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,305.71 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,315.39 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$33.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $3,315.39 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
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 H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $3,331.20 |
Browse Plan Formulary |
CareSource Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | P | $3,785.45 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $3,502.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $3,502.24 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $3,502.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,485.58 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,380.63 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $3,295.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,477.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,475.17 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,574.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
3 |
Tier 3 |
25% | 25% | None | $3,611.76 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $3,595.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,458.24 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,471.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P Q:1 /28Days | $3,478.60 |
Browse Plan Formulary |