ZYVOX 600MG TABLET (20 BOTPL) (NDC: 00009513502)
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 |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
5 |
Tier 5 |
33% | n/a | P Q:20 /1Days | $5,099.92 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,868.02 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,863.27 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Opt
|
$9.30 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $5,029.08 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.38 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$11.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,795.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 |
to be determined |
4 |
Tier 4 |
25% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,868.02 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,725.59 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,725.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,725.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,725.59 |
Browse Plan Formulary |
Humana Gold Choice H2944-044 (PFFS)
|
$19.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,725.59 |
Browse Plan Formulary |
HealthPlus MedicarePlus - AdvantageHMO Opt
|
$19.10 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $5,029.08 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$21.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,841.30 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
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 |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
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 |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Fidelis Secure at Home (HMO)
|
$21.30 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
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 |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
Browse Plan Formulary |
Humana Gold Choice H2944-047 (PFFS)
|
$21.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,757.42 |
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 |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,779.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,779.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,779.46 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$22.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,779.46 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.17 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
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 |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$24.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-051 (PFFS)
|
$24.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,748.74 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,803.08 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,794.70 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,785.60 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.99 |
Browse Plan Formulary |
Medicare Plus Blue Option A (PFFS)
|
$26.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,802.31 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,871.38 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,814.06 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,830.40 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.71 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$26.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,861.70 |
Browse Plan Formulary |
HumanaChoice H5470-004 (PPO)
|
$27.00 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,754.73 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,824.88 |
Browse Plan Formulary |
PriorityMedicare Choice (PPO)
|
$27.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,824.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | P | $4,805.50 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$28.70 |
$0 |
to be determined |
3 |
Tier 3 |
$50.00 | $150.00 | P | $4,805.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
Humana Gold Choice H2944-049 (PFFS)
|
$30.50 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,742.11 |
Browse Plan Formulary |
HumanaChoice R5826-006 (Regional PPO)
|
$33.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,743.81 |
Browse Plan Formulary |
HumanaChoice R5826-072 (Regional PPO)
|
$33.60 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | None | $4,743.81 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Humana Gold Choice H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-046 (PFFS)
|
$34.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | None | $4,747.29 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$34.90 |
$310 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $4,770.22 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,888.13 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,888.13 |
Browse Plan Formulary |
Great Lakes Personal Care Plus (HMO)
|
$34.90 |
$310 |
to be determined |
2 |
Tier 2 |
15% | 15% | P | $4,888.13 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
$83.00 | $249.00 | P | $4,805.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
$83.00 | $249.00 | P | $4,805.50 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
$83.00 | $249.00 | P | $4,805.50 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
$83.00 | $249.00 | P | $4,805.50 |
Browse Plan Formulary |
Healthy Advantage (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
$83.00 | $249.00 | P | $4,805.50 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
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 |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$36.00 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,785.69 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,863.27 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,808.34 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue PPO (PPO)
|
$39.50 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.26 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,811.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.98 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,817.35 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,809.09 |
Browse Plan Formulary |
Medicare Plus Blue Option B (PFFS)
|
$40.40 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,863.56 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,876.61 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,033.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,036.41 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $5,030.00 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
PriorityMedicare Plus (HMO-POS)
|
$48.80 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.60 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,769.94 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,769.94 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,769.94 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$50.20 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,769.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,864.36 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
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 |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$52.90 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,761.22 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | Q:56 /28Days | $4,862.84 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$57.20 |
$0 |
to be determined |
4 |
Tier 4 |
33% | 33% | P | $4,770.22 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.95 |
Browse Plan Formulary |
PriorityMedicare Plus (HMO-POS)
|
$57.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | P | $4,764.95 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,814.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,818.76 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,830.40 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,815.71 |
Browse Plan Formulary |
BCN Advantage (HMO)
|
$58.70 |
$0 |
to be determined |
4 |
Tier 4 |
25% | n/a | None | $4,861.70 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$59.60 |
$0 |
to be determined |
4 |
Tier 4 |
33% | n/a | P | $4,770.22 |
Browse Plan Formulary |