Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Adams |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Boone |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Brown |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Bureau |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Carroll |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Cass |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Champaign |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Christian |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Coles |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Crawford |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Cumberland |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
De Witt |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
DeKalb |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Douglas |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Effingham |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Fayette |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Ford |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Fulton |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Hancock |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Henderson |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Henry |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Jasper |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Jo Daviess |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Kendall |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Lee |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Logan |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Macon |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Macoupin |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Marshall |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Mason |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
McLean |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Menard |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Mercer |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Montgomery |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Morgan |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Moultrie |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Ogle |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Peoria |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Piatt |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Pike |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Rock Island |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Sangamon |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Scott |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Shelby |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Stark |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Stephenson |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Tazewell |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Vermilion |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 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 |
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Warren |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Winnebago |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Advantra (PPO) in IL - H7301-002-0
Benefit Details
|
Woodford |
$29.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Generic: $10.00 Preferred Brand: $47.00 Non-Preferred Brand: 50% Specialty Tier: 33%
| $4,200 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|