Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Barrow |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Candler |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Chatham |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Chattooga |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Clayton |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
DeKalb |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Elbert |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Forsyth |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Franklin |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Fulton |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Glascock |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Gwinnett |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Habersham |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Hancock |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Hart |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Henry |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Jackson |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Jefferson |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Lincoln |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Morgan |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Muscogee |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Polk |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Randolph |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Rockdale |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Talbot |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Taliaferro |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Walton |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Warren |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Washington |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
White |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in GA - H8145-069-0
Benefit Details
|
Wilkes |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Abbeville |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Aiken |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Anderson |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Bamberg |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Beaufort |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Edgefield |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Greenville |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Jasper |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Lee |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Oconee |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Richland |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
Spartanburg |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-069 (PFFS) in SC - H8145-069-0
Benefit Details
|
York |
$83.00 |
$290 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $17.00 Preferred Brand: $47.00 Non-Preferred Drug: $97.00 Specialty Tier: 27%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|