ARANESP 200MCG/ML VIAL (200MCG/ 1ML VIALSD) (NDC: 55513000601)
2013 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Additional Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,280.50 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,280.50 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,280.50 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,280.50 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,404.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Select Plan (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,404.80 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | Many Generics | 6 |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan I (HMO)
|
$0.00 |
$0 | Many Generics | 6 |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 | Many Generics | 6 |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Blue Cross Senior Secure Plan II (HMO)
|
$0.00 |
$0 | Many Generics | 6 |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,251.50 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,251.50 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,251.50 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Brand |
$40.00 | $80.00 | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Brand New Day (HMO)
|
$0.00 |
$0 | Many Generics | 2 |
Brand |
$40.00 | $80.00 | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $5,395.57 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $5,395.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $5,395.57 |
Browse Plan Formulary |
Care1st TotalAdvantage Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
30% | 30% | P | $5,395.57 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325 | All Generics, Few Brands | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $5,821.88 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$325 | All Generics, Few Brands | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $5,821.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 | All Generics, All Brands | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 | All Generics | 5 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$0.00 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:5 /30Days | $5,572.65 |
Browse Plan Formulary |
Citizens Choice Healthplan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | n/a | P Q:5 /30Days | $5,572.65 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,464.68 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,464.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,505.48 |
Browse Plan Formulary |
Freedom VIP Care (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,505.48 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,505.48 |
Browse Plan Formulary |
Freedom VIP Care COPD (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,505.48 |
Browse Plan Formulary |
Golden State Medicare Health Plan, Golden (HMO) (HMO)
|
$0.00 |
$0 | Many Generics | 4 |
Specialty Tier |
33% | 33% | P Q:4 /28Days | $5,281.37 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Gold Select (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Ruby Plan 1 (HMO)
|
$0.00 |
$0 | Many Generics | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 | Some Generics | 5 |
Specialty Tier |
25% | n/a | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Inter Valley Health Plan Total Fit (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$65.00 | $130.00 | P | $5,638.87 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$65.00 | $130.00 | P | $5,638.87 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
$60.00 | $120.00 | P | $5,554.86 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 | All Generics, Few Brands | 4 |
Non-Preferred Brand |
$60.00 | $120.00 | P | $5,554.86 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
StartSmart with CareMore (HMO)
|
$0.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | n/a | P Q:4 /28Days | $5,827.31 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $5,638.87 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$11.40 |
$0 | No additional gap coverage, only the Donut Hole Discount | 4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $5,638.87 |
Browse Plan Formulary |
Health Net Healthy Heart Plan 2 (HMO)
|
$23.90 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,280.50 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO SNP)
|
$26.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,280.50 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90* | No additional gap coverage, only the Donut Hole Discount | 6* |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$28.00 |
$90* | No additional gap coverage, only the Donut Hole Discount | 6* |
Specialty Tier |
33% | n/a | P | $5,585.24 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Brand New Day (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Brand New Day D SNP (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
15% | 15% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Brand New Day HMO Extra Care (HMO)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 2 |
Tier 2 |
25% | 25% | P Q:4 /28Days | $5,512.45 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 | Few Generics | 5 |
Specialty Tier |
25% | 25% | P | $5,395.57 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$29.80 |
$325 | Few Generics | 5 |
Specialty Tier |
25% | 25% | P | $5,395.57 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,276.11 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,275.46 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Tier 5 |
15% | 15% | P | $5,275.46 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $5,252.45 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO SNP)
|
$29.80 |
$325 | No additional gap coverage, only the Donut Hole Discount | 4 |
Specialty Tier |
25% | n/a | P | $5,252.45 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,435.76 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,475.58 |
Browse Plan Formulary |
Freedom Plan (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
25% | 25% | P Q:4 /28Days | $5,475.58 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | P Q:4 /28Days | $5,475.58 |
Browse Plan Formulary |
L.A. Care Health Plan Medicare Advantage (HMO SNP)
|
$29.90 |
$325 | No additional gap coverage, only the Donut Hole Discount | 1 |
Tier 1 |
n/a | n/a | P Q:4 /28Days | $5,475.58 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart Plan 2 (HMO)
|
$39.00 |
$0 | No additional gap coverage, only the Donut Hole Discount | 5 |
Specialty Tier |
33% | 33% | P | $5,276.11 |
Browse Plan Formulary |