VIVITROL INJECTABLE SUSPENSION 380MG/VIAL (NDC: 65757030001)
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 |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Advantage Solution Standard with Rx
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Value Plus (HMO-POS)
|
$6.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $955.65 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-002 (PFFS)
|
$14.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-072 (PFFS)
|
$25.80 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P | $949.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-003 (PFFS)
|
$26.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $954.22 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
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 |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
UCare for Seniors Classic (HMO-POS)
|
$31.50 |
$0 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $1,027.68 |
Browse Plan Formulary |
HumanaChoice H6609-005 (PPO)
|
$36.90 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $947.59 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
HumanaChoice H6609-007 (PPO)
|
$37.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $964.58 |
Browse Plan Formulary |
Medica Prime Solution Value (Cost)
|
$38.00 |
$55 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $965.26 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Std Rx - MN
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medica Prime Solution Enhanced w/Std. Rx -
|
$38.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Prime Solution Basic w/Enhanced Rx
|
$67.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |
Medica Prime Solution Enhanced w/Enhanced
|
$67.90 |
$0 | to be determined | 3 |
Tier 3 |
$74.00 | $148.00 | None | $966.42 |
Browse Plan Formulary |