STIMATE 1.5MG/ML NASAL SPRAY (2.5 ML BOTSPR) (NDC: 00053245300)
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 |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $578.66 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $578.66 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $579.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $579.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $579.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $579.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $602.53 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $50.00 | None | $548.66 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$25.00 | $50.00 | None | $548.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $150.00 | None | $582.91 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | None | $619.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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 |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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 |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$39.00 | $97.50 | None | $578.66 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $587.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $587.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $587.61 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $587.61 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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 Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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 Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $565.03 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $573.30 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $578.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $571.31 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 2 |
Tier 2 |
25% | n/a | None | $590.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.63 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$16.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $591.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $569.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | None | $589.44 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
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
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $589.93 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$19.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $569.70 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | None | $578.66 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | None | $552.43 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | None | $579.39 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | None | $579.39 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | None | $575.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $578.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $552.43 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $578.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $578.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $578.66 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $578.66 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 | to be determined | 2 |
Tier 2 |
$43.00 | $107.50 | None | $578.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $579.39 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
$95.00 | $285.00 | None | $582.91 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $545.16 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $571.31 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $575.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$40.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $609.15 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.49 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $593.41 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $579.39 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $589.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $586.45 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $588.77 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | n/a | None | $590.48 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | None | $579.64 |
Browse Plan Formulary |