ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA] (0.4 ML ) (NDC: 00074937402)
2020 Medicare Prescription Drug Plan (MAPD) Information
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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 |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,836.72 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,348.04 |
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 |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
Covenant Advantage (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,561.18 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
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 |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
|
$0.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,565.50 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,565.50 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,348.04 |
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 |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | n/a |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | n/a |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $5,566.24 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $5,348.04 |
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 |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P Q:2 /28Days | $5,566.24 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
|
$14.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | n/a |
Browse Plan Formulary |
Humana Value Plus H8087-002 (PPO)
|
$15.60 |
$260 |
No |
5 |
Tier 5 |
28% | n/a | P Q:6 /28Days | $5,834.82 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$18.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$18.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,474.08 |
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 |
Medicare Plus Blue PPO Essential (PPO)
|
$18.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$18.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$18.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$18.60 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $5,868.16 |
Browse Plan Formulary |
HumanaChoice H8087-001 (PPO)
|
$19.00 |
$195 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,834.82 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$20.60 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $5,868.16 |
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 |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$23.00 |
$210 |
No |
5 |
Tier 5 |
29% | n/a | P Q:6 /28Days | $5,834.82 |
Browse Plan Formulary |
WellCare Extra Smile (HMO-POS D-SNP)
|
$23.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $5,868.16 |
Browse Plan Formulary |
HumanaChoice SNP-DE H8087-003 (PPO D-SNP)
|
$23.60 |
$395 |
No |
5 |
Tier 5 |
25% | n/a | P Q:6 /28Days | $5,834.82 |
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 |
Covenant Advantage Plus (HMO-POS)
|
$25.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,561.18 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.20 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P Q:2 /28Days | $5,418.04 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
|
$30.20 |
$435 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /28Days | $5,539.20 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.20 |
$435 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | P | $5,864.82 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,565.50 |
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 |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | P Q:2 /28Days | $5,565.50 |
Browse Plan Formulary |
WellCare Elite (HMO-POS)
|
$47.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | n/a |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
|
$56.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (PPO)
|
$56.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
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 |
HumanaChoice H5216-009 (PPO)
|
$74.00 |
$105 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,695.74 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
|
$76.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$84.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$84.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$84.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$84.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,348.04 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$84.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,566.24 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,566.24 |
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 |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,565.50 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,565.50 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$123.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,474.08 |
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 |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$123.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$123.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$123.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$123.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$149.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.16 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,474.08 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$151.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$181.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,566.24 |
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 |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,566.24 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,348.04 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:2 /28Days | $5,634.78 |
Browse Plan Formulary |
HAP Senior Plus Option 4 (PPO)
|
$200.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $5,501.42 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,474.08 |
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 |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$241.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$299.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$299.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,474.08 |
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 |
Medicare Plus Blue PPO Assure (PPO)
|
$299.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,348.04 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$299.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$299.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:6 /28Days | $5,559.16 |
Browse Plan Formulary |