ACCOLATE 20MG TABLET (60 BOTPL) (NDC: 00310040260)
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 |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Choice + Rx (HMO-POS)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Amerivantage Classic + Rx (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | None | $105.33 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Classic (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$6.50 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (HMO)
|
$7.30 |
$100 |
to be determined |
3 |
Tier 3 |
$95.00 | $238.00 | None | $105.88 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Bravo Choice (HMO)
|
$8.30 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.89 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 |
to be determined |
4 |
Tier 4 |
$70.00 | $140.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $108.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $108.38 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.90 |
$310 |
to be determined |
2 |
Tier 2 |
25% | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 |
to be determined |
4 |
Tier 4 |
$60.00 | $120.00 | Q:180 /90Days | $105.98 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (HMO)
|
$17.60 |
$0 |
to be determined |
4 |
Tier 4 |
$78.00 | $156.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Standard Plan (PPO)
|
$17.80 |
$100 |
to be determined |
4 |
Tier 4 |
$68.00 | $136.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | Q:60 /30Days | $112.50 |
Browse Plan Formulary |
Bravo Premier Plus (HMO-POS)
|
$22.20 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.88 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$28.30 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.50 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.85 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.85 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.85 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$29.80 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $160.00 | Q:180 /90Days | $105.85 |
Browse Plan Formulary |
Amerivantage Specialty + Rx (HMO)
|
$30.20 |
$310 |
to be determined |
4 |
Tier 4 |
$90.00 | $180.00 | None | $105.33 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$33.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$33.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | Q:180 /90Days | $105.88 |
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 |
Evercare Plan IP (PPO)
|
$33.70 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | S Q:62 /31Days | $104.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $108.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $108.38 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.83 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
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 |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$37.10 |
$0 |
to be determined |
2 |
Tier 2 |
$35.00 | n/a | S Q:60 /30Days | $107.42 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$55.20 |
$0 |
to be determined |
4 |
Tier 4 |
$80.00 | $160.00 | Q:2 /1Days | $105.44 |
Browse Plan Formulary |