ZEMPLAR 5MCG/ML VIAL (NDC: 00074165802)
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 Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Advantra Platinum PPO (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Platinum PPO SW (PPO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
Advantra Silver SW (HMO)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | $87.50 | None | $4,871.46 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $5,041.72 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $116.00 | None | $4,847.66 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-004 (PFFS)
|
$16.00 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
AARP MedicareComplete Plan 2 (HMO)
|
$17.30 |
$0 |
to be determined |
2 |
Tier 2 |
$24.00 | $62.00 | None | $5,041.72 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |
Humana Gold Choice H2944-005 (PFFS)
|
$24.30 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $4,819.10 |
Browse Plan Formulary |