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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Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Adams | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Barnes | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Bowman | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Burleigh | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Cass | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Cavalier | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Dickey | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Dunn | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Eddy | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Emmons | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Foster | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Grand Forks | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Grant | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Griggs | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Hettinger | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Kidder | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
LaMoure | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Logan | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
McHenry | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
McIntosh | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
McLean | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Mercer | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Morton | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Oliver | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Pembina | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Pierce | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Ransom | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Richland | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Sargent | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Sheridan | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Sioux | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Stark | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Steele | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Stutsman | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Traill | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Walsh | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in ND - H2450-027-0 Benefit Details |
Ward | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Aurora | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Beadle | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Bennett | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Bon Homme | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Brookings | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Brown | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Brule | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Buffalo | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Butte | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Campbell | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Charles Mix | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Clark | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Clay | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Codington | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Custer | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Davison | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Day | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Deuel | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Dewey | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Douglas | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Edmunds | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Fall River | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Grant | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Gregory | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Haakon | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Hamlin | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Hand | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Hanson | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Harding | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Hughes | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Hutchinson | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Jackson | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Jerauld | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Jones | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Kingsbury | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Lake | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Lawrence | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Lincoln | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Lyman | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Marshall | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
McCook | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
McPherson | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Meade | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Mellette | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Miner | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Minnehaha | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Moody | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Pennington | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Perkins | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Roberts | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Sanborn | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Shannon | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Spink | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Stanley | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Todd | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Tripp | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Turner | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Union | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Yankton | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 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 | |||||||||
Medica Prime Solution Value Plus w/Std Rx - ND/SD (Cost) in SD - H2450-027-0 Benefit Details |
Ziebach | $98.30 | $0 | No additional gap coverage, only the Donut Hole Discount | Generic Drugs: $10.00 Preferred Brand Drugs: $34.00 Non-Preferred Brand Drugs: $74.00 Specialty Tier Drugs: 25% | $3,350 Browse Formulary | |||||
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