UVADEX SOLUTION STERILE 20MCG/ML (12 X 10 ML VIAL) (NDC: 64067021601)
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 |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $215.00 | None | $431.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $215.00 | None | $431.39 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $215.00 | None | $431.39 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $858.76 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $431.39 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $431.39 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
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 |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $87.50 | P | $1,003.13 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2649-015 (HMO)
|
$30.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |
HumanaChoice H1716-001 (PPO)
|
$33.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $986.47 |
Browse Plan Formulary |