Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Adams |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Allen |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Bartholomew |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Benton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Blackford |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Boone |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Brown |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Carroll |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Cass |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Clark |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Clay |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Clinton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Crawford |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Daviess |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
De Kalb |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Dearborn |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Decatur |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Delaware |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Dubois |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Elkhart |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Fayette |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Floyd |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Fountain |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Franklin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Fulton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Gibson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Grant |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Greene |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Hamilton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Hancock |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Harrison |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Hendricks |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Henry |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Howard |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Huntington |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Jackson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Jasper |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Jay |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Jefferson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Jennings |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Johnson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Knox |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Kosciusko |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
La Porte |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Lagrange |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Lake |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Lawrence |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Madison |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Marion |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Marshall |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Martin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Miami |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Monroe |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Montgomery |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Morgan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Newton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Noble |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Ohio |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Orange |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Owen |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Parke |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Perry |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Pike |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Porter |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Posey |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Pulaski |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Putnam |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Randolph |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Ripley |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Rush |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Scott |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Shelby |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Spencer |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
St. Joseph |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Starke |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Steuben |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Sullivan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Switzerland |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Tippecanoe |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Tipton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Union |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Vanderburgh |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Vermillion |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Vigo |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Wabash |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Warren |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Warrick |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Washington |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Wayne |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Wells |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
White |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in IN - R5941-015-0
Benefit Details
|
Whitley |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Adair |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Allen |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Anderson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Ballard |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Barren |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Bath |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Bell |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Boone |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Bourbon |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Boyd |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Boyle |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Bracken |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Breathitt |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Breckinridge |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Bullitt |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Butler |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Caldwell |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Calloway |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Campbell |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Carlisle |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Carroll |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Carter |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Casey |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Christian |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Clark |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Clay |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Clinton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Crittenden |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Cumberland |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Daviess |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Edmonson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Elliott |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Estill |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Fayette |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Fleming |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Floyd |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Franklin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Fulton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Gallatin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Garrard |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Grant |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Graves |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Grayson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Green |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Greenup |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Hancock |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Hardin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Harlan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Harrison |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Hart |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Henderson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Henry |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Hickman |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Hopkins |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Jackson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Jefferson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Jessamine |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Johnson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Kenton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Knott |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Knox |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Larue |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Laurel |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Lawrence |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Lee |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Leslie |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Letcher |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Lewis |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Lincoln |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Livingston |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Logan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Lyon |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Madison |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Magoffin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Marion |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Marshall |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Martin |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Mason |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
McCracken |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
McCreary |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
McLean |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Meade |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Menifee |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Mercer |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Metcalfe |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Monroe |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Montgomery |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Morgan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Muhlenberg |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Nelson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Nicholas |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Ohio |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Oldham |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Owen |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Owsley |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Pendleton |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Perry |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Pike |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Powell |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Pulaski |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Robertson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Rockcastle |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Rowan |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Russell |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Scott |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Shelby |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Simpson |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Spencer |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Taylor |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Todd |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Trigg |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Trimble |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Union |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Warren |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Washington |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Wayne |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Webster |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Whitley |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 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 |
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Wolfe |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Access (Regional PPO) in KY - R5941-015-0
Benefit Details
|
Woodford |
$63.00 |
$0 |
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: 33% Select Care Drugs: $0.00
| $6,400 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|