ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE (BLISTER PACK ) (NDC: 55513002304)
2016 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,832.49 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 1 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,832.49 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,832.49 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 2 (HMO)
|
$0.00 |
$0 |
to be determined |
5 |
Specialty Tier |
33% | 33% | P | $1,832.49 |
Browse Plan Formulary |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:1 /28Days | $1,819.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Prime Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:1 /28Days | $1,819.13 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,829.19 |
Browse Plan Formulary |
Anthem MediBlue Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,829.19 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,839.40 |
Browse Plan Formulary |
Anthem MediBlue Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $285.00 | P | $1,839.40 |
Browse Plan Formulary |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Specialty Tier |
33% | n/a | P Q:1 /28Days | $1,802.02 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Shield 65 Plus (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Specialty Tier |
33% | n/a | P Q:1 /28Days | $1,802.02 |
Browse Plan Formulary |
Blue Shield 65 Plus Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
6 |
Tier 6 |
33% | n/a | P Q:1 /28Days | $1,802.02 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$35.00 | $87.50 | P | $1,809.40 |
Browse Plan Formulary |
Care1st AdvantageOptimum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$35.00 | $87.50 | P | $1,809.40 |
Browse Plan Formulary |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,815.98 |
Browse Plan Formulary |
Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,815.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Breathe (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
0% | 0% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Tier 2 |
0% | 0% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Connect (HMO SNP)
|
$0.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore ESRD (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Heart (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Reliance (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $237.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore StartSmart Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $237.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Touch (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Value Plus (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$85.00 | $212.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Central Health Focus Plan (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Focus Plan (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Medicare Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | P | $1,821.74 |
Browse Plan Formulary |
Easy Choice Best Plan (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | P | $1,821.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Golden State Medicare Health Plan, Golden (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P Q:1 /28Days | $1,816.09 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,819.65 |
Browse Plan Formulary |
Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,819.65 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,825.44 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.75 |
Browse Plan Formulary |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,825.44 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Gold Select (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.75 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.76 |
Browse Plan Formulary |
Health Net Jade (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.76 |
Browse Plan Formulary |
Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,832.46 |
Browse Plan Formulary |
Heart & Diabetes (HMO SNP)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,832.46 |
Browse Plan Formulary |
Inter Valley Health Plan Service To Seniors (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $237.50 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | P | $1,839.67 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage B Only South (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Tier 4 |
$95.00 | $190.00 | P | $1,839.67 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $1,839.67 |
Browse Plan Formulary |
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P | $1,839.67 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,786.53 |
Browse Plan Formulary |
L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
to be determined |
2 |
Brand Drugs |
0% | 0% | P | $1,786.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
My Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,831.82 |
Browse Plan Formulary |
My Choice Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,831.82 |
Browse Plan Formulary |
Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,832.46 |
Browse Plan Formulary |
Platinum Plan (HMO)
|
$0.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P | $1,832.46 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$12.00 |
$360 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | P | $1,821.74 |
Browse Plan Formulary |
Easy Choice Plus Plan (HMO)
|
$12.00 |
$360 |
to be determined |
3 |
Preferred Brand |
$47.00 | $117.50 | P | $1,821.74 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,825.44 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.75 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,825.44 |
Browse Plan Formulary |
Health Net Healthy Heart (HMO)
|
$20.00 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$90.00 | $260.00 | P | $1,834.75 |
Browse Plan Formulary |
CareMore Connect Plus (HMO)
|
$22.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
CareMore Connect Plus (HMO)
|
$22.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P | $1,839.67 |
Browse Plan Formulary |
Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)
|
$25.20 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $200.00 | P | $1,839.67 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$27.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:1 /28Days | $1,816.87 |
Browse Plan Formulary |
Aetna Medicare Select Plan (HMO)
|
$27.00 |
$0 |
to be determined |
3 |
Preferred Brand |
$47.00 | $141.00 | P Q:1 /28Days | $1,816.87 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,818.11 |
Browse Plan Formulary |
AARP MedicareComplete SecureHorizons Plan 3 (HMO)
|
$27.40 |
$360 |
to be determined |
5 |
Tier 5 |
25% | 25% | P | $1,818.11 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem MediBlue Coordination Plus (HMO)
|
$31.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$92.00 | $276.00 | P | $1,829.19 |
Browse Plan Formulary |
Anthem MediBlue Coordination Plus (HMO)
|
$31.00 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
$92.00 | $276.00 | P | $1,829.19 |
Browse Plan Formulary |
CalPlus Plan (HMO)
|
$31.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,832.66 |
Browse Plan Formulary |
CalPlus Plan (HMO)
|
$31.00 |
$360 |
to be determined |
4 |
Tier 4 |
25% | 25% | P | $1,832.66 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
3 |
Preferred Brand |
25% | 25% | P | $1,815.98 |
Browse Plan Formulary |
Care1st TotalDual Plan (HMO SNP)
|
$31.00 |
$360 |
to be determined |
3 |
Preferred Brand |
25% | 25% | P | $1,815.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
3 |
Preferred Brand |
25% | 25% | P | $1,809.69 |
Browse Plan Formulary |
Coordinated Choice Plan (HMO)
|
$31.00 |
$360 |
to be determined |
3 |
Preferred Brand |
25% | 25% | P | $1,809.69 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.93 |
Browse Plan Formulary |
Health Net Seniority Plus Amber I (HMO SNP)
|
$31.00 |
$270 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.93 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,821.28 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,821.28 |
Browse Plan Formulary |
Health Net Seniority Plus Amber II (HMO SNP)
|
$31.00 |
$280 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.82 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,821.28 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.80 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,821.28 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire (HMO)
|
$31.00 |
$290 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.82 |
Browse Plan Formulary |
Health Net Seniority Plus Sapphire Premier (HMO)
|
$31.00 |
$310 |
to be determined |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P | $1,820.82 |
Browse Plan Formulary |
Central Health Advance Plan (HMO SNP)
|
$31.10 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Advance Plan (HMO SNP)
|
$31.10 |
$0 |
to be determined |
4 |
Non-Preferred Brand |
$75.00 | $150.00 | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$31.10 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Medi-Medi Plan (HMO SNP)
|
$31.10 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Central Health Premier Plan (HMO)
|
$31.10 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |
Central Health Premier Plan (HMO)
|
$31.10 |
$360 |
to be determined |
4 |
Non-Preferred Brand |
25% | 25% | P Q:1 /28Days | $1,846.30 |
Browse Plan Formulary |