SULFADIAZINE 500MG TABLET (1000 BOTPL) (NDC: 00185075710)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
$20.00 | $40.00 | None | $456.46 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $481.63 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $481.63 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $481.63 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $481.63 |
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 |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$0.00 | $0.00 | None | $481.63 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$3.00 | $6.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
|
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$4.00 | $10.00 | None | $474.72 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $463.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $463.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $463.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $463.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$45.00 | $125.00 | None | $461.54 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $478.75 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $478.75 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$45.00 | $125.00 | None | $464.38 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $498.68 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$5.00 | $10.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$35.00 | $75.00 | None | $432.77 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $445.57 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $434.03 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$8.00 | $12.00 | None | $532.84 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $465.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.50 | None | $474.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.48 |
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
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.01 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
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 Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $404.23 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.51 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $474.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $474.96 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $491.16 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.51 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $474.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $474.96 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $491.16 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
2 |
Tier 2 |
$42.00 | $116.00 | None | $474.96 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $460.99 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $10.00 | None | $474.72 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $542.21 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
1 |
Tier 1 |
25% | n/a | None | $484.71 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 |
to be determined |
2 |
Tier 2 |
$10.00 | $20.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $477.51 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
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 |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $495.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $536.28 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | None | $482.54 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 |
to be determined |
3 |
Tier 3 |
$40.00 | $120.00 | None | $482.54 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $482.54 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $479.38 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$19.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $491.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
HealthSpring TotalCare (HMO)
|
$20.30 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | None | $472.17 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $456.75 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
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 |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.44 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $360.86 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $17.50 | None | $362.11 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 |
to be determined |
2 |
Tier 2 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 |
to be determined |
1 |
Tier 1 |
$4.00 | $8.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $475.92 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $475.92 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $475.92 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $475.92 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $475.92 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $475.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $14.00 | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $579.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $579.72 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 |
to be determined |
1 |
Tier 1 |
$0.00 | $0.00 | None | $427.06 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $482.86 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Select (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
15% | 15% | None | $498.68 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $498.68 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $498.68 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $498.68 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $498.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Silver Rx (Regional
|
$27.50 |
$0 |
to be determined |
1 |
Tier 1 |
$9.00 | $22.50 | None | $474.72 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | None | $463.37 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 |
to be determined |
2 |
Tier 2 |
$45.00 | $135.00 | None | $432.77 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$28.30 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $434.03 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
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 |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | None | $481.66 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $445.57 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $445.57 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $445.57 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $445.57 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 |
to be determined |
3 |
Tier 3 |
$70.00 | $195.00 | None | $445.57 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $568.87 |
Browse Plan Formulary |
Plan Name |
Monthly 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 R5826-075 (Regional PPO)
|
$33.10 |
$310 |
to be determined |
1 |
Tier 1 |
25% | 25% | None | $542.21 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 |
to be determined |
1 |
Tier 1 |
$7.00 | $0.00 | None | $557.74 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $403.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $403.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.01 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$40.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $491.16 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $456.46 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $456.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $481.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $496.35 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $517.37 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $527.83 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
1 |
Tier 1 |
$10.00 | $20.00 | None | $487.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $463.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $463.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $463.92 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 |
to be determined |
2 |
Tier 2 |
$30.00 | $60.00 | None | $463.92 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $463.37 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 |
to be determined |
3 |
Tier 3 |
$65.00 | $130.00 | None | $463.37 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $480.65 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $476.47 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $476.47 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $476.47 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $476.47 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $476.47 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $476.47 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $471.62 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | $12.50 | None | $518.46 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $442.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $486.27 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Plan Name |
Monthly 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 |
1 |
Tier 1 |
$5.00 | n/a | None | $483.12 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
1 |
Tier 1 |
$5.00 | n/a | None | $484.71 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 |
to be determined |
3 |
Tier 3 |
$30.00 | $90.00 | None | $472.17 |
Browse Plan Formulary |