WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Anderson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Bedford |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Benton |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Bledsoe |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Blount |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Bradley |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Campbell |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Cannon |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Carroll |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Carter |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Cheatham |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Chester |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Claiborne |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Clay |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Cocke |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Coffee |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Crockett |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Cumberland |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Davidson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Decatur |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
DeKalb |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Dyer |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Fayette |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Fentress |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Franklin |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Giles |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Grainger |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Greene |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Grundy |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hamblen |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hamilton |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hancock |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hardeman |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hardin |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Haywood |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Henderson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Henry |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Hickman |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Houston |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Jackson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Jefferson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Johnson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Knox |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Lake |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Lauderdale |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Lawrence |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Lewis |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Loudon |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
McMinn |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
McNairy |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Macon |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Madison |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Marion |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Marshall |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
|
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Maury |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Meigs |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Monroe |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Montgomery |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Moore |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Morgan |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Obion |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Overton |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Perry |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Pickett |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Polk |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Rhea |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Roane |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Robertson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Rutherford |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Scott |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Sequatchie |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Sevier |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Shelby |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Smith |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Stewart |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Sullivan |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Tipton |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Trousdale |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Unicoi |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Union |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Van Buren |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Warren |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Washington |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Wayne |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Weakley |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
White |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Williamson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
WellCare Plus (HMO) in TN - H1416-063-0
Benefit Details
|
Wilson |
$18.40 |
$435 Tier 1 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 48% Specialty Tier: 25%
| $3,400 Browse Formulary |
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