2011 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Atkinson | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Brantley | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Brooks | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Calhoun | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Chattooga | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Crawford | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Emanuel | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Glascock | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Glynn | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Hall | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Houston | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Macon | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Madison | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Mitchell | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Oglethorpe | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Putnam | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Rabun | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Randolph | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Seminole | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Spalding | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Thomas | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Walker | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Warren | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Wayne | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Webster | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in GA - H1689-013-0 Benefit Details |
Wilkinson | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Belknap | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Carroll | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Cheshire | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Grafton | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Hillsborough | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Merrimack | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Rockingham | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Strafford | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in NH - H1689-013-0 Benefit Details |
Sullivan | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Alleghany | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Amherst | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Appomattox | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Augusta | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Bath | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Bedford | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Bedford City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Brunswick | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Buena Vista City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Campbell | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Carroll | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Covington City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Craig | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Culpeper | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Danville City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Emporia City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Fauquier | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Floyd | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Fredericksburg City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Galax City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Giles | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Greensville | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Halifax | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Harrisonburg City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Henry | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Highland | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
King George | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Lexington City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Lynchburg City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Martinsville City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Mecklenburg | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
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SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Patrick | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Pittsylvania | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Pulaski | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Radford City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Rockbridge | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Rockingham | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
South Boston City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Spotsylvania | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Stafford | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Staunton City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Waynesboro City | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
SmartValue Plus (PFFS) in VA - H1689-013-0 Benefit Details |
Westmoreland | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
SmartValue Plus (PFFS) in WI - H1689-013-0 Benefit Details |
Walworth | $42.00 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $44.00 Non-Preferred Brand Drugs: $85.00 Injectable Drugs: 33% Specialty Tier Drugs: 33% Supplemental Drugs: $8.00 | $5,000 Browse Formulary | |||||
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