Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Adams |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Allen |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Blackford |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Boone |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Brown |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Clark |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Clay |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Clinton |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Crawford |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Dearborn |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Decatur |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Dubois |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Fayette |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Floyd |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Fountain |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Fulton |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Gibson |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Hamilton |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Hancock |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Harrison |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Hendricks |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Henry |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Howard |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Huntington |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Jackson |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Jay |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Jefferson |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Jennings |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Johnson |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Knox |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Kosciusko |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Lawrence |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Madison |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Marion |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Marshall |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Martin |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Miami |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Montgomery |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Morgan |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Newton |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Noble |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Orange |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Owen |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Parke |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Perry |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Pike |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Posey |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Pulaski |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Putnam |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Randolph |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Rush |
$93.00 |
$220 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: 28%
| 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 H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
St. Joseph |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Scott |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Spencer |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Starke |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Steuben |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Switzerland |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Tipton |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Union |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Vanderburgh |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Vigo |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Warren |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Warrick |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Wells |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-011 (PFFS) in IN - H8145-011-0
Benefit Details
|
Whitley |
$93.00 |
$220 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: 28%
| n/a Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|