AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Baxter |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Boone |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Conway |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Crawford |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Franklin |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Fulton |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Johnson |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Lee |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Lincoln |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Logan |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Marion |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Newton |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Ouachita |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Perry |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Phillips |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Pope |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Scott |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Searcy |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Sebastian |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
St. Francis |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-1
Benefit Details
|
Van Buren |
$26.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-5
Benefit Details
|
Benton |
$30.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-5
Benefit Details
|
Carroll |
$30.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-5
Benefit Details
|
Madison |
$30.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-5
Benefit Details
|
Washington |
$30.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Clark |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Crittenden |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Dallas |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Faulkner |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Garland |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Hot Spring |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Howard |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Izard |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Mississippi |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Monroe |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Montgomery |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Nevada |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Pike |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Polk |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Union |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
White |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Woodruff |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-2
Benefit Details
|
Yell |
$89.90 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-6
Benefit Details
|
Cleburne |
$80.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-6
Benefit Details
|
Jefferson |
$80.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-6
Benefit Details
|
Lonoke |
$80.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) in AR - H4213-017-6
Benefit Details
|
Pulaski |
$80.00 |
$290 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $13.00 Preferred Brand: $42.00 Non-Preferred Brand: $95.00 Specialty Tier: 25%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|