TYMLOS 80 MCG DOSE PEN INJECTR (1.56 ML ) (NDC: 70539000102)
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 Better Health Premier Plan (Medicare-Medicaid Plan)
|
$0.00 |
$0 | No | 2 |
Tier 2 |
0% | 0% | P | $2,545.42 |
Browse Plan Formulary |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | $2,547.38 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 | No | 5 |
Tier 5 |
30% | n/a | P | $2,547.52 |
Browse Plan Formulary |
Align Connect (HMO C-SNP)
|
$0.00 |
$435 | No | 5 |
Tier 5 |
25% | n/a | None | $2,524.66 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
|
$0.00 |
$0 | No | 2 |
Tier 2 |
0% | 0% | P | $2,459.80 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,445.18 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.90 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,463.74 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,437.76 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,416.32 |
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 | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,453.66 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,468.06 |
Browse Plan Formulary |
HAP Empowered MI Health Link (Medicare-Medicaid Plan)
|
$0.00 |
$0 | No | 2 |
Tier 2 |
0% | 0% | S | $2,446.22 |
Browse Plan Formulary |
HAP Primary Choice Medicare (HMO)
|
$0.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,472.54 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
|
$0.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
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 |
Michigan Complete Health (Medicare-Medicaid Plan)
|
$0.00 |
$0 | No | 2 |
Tier 2 |
0% | 0% | P | $2,528.62 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 | No | 2 |
Tier 2 |
0% | 0% | P | $2,458.00 |
Browse Plan Formulary |
Principle (HMO)
|
$0.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P | $2,556.30 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
|
$0.00 |
$75 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,449.92 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,450.52 |
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 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
|
$0.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,450.38 |
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)
|
$9.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,416.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,437.54 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,468.06 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P Q:2 /30Days | $2,451.18 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P Q:2 /30Days | $2,449.24 |
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 Ideal (PPO)
|
$14.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P Q:2 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 | No | 5 |
Tier 5 |
30% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
|
$14.10 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$18.60 |
$435 | No | 5 |
Tier 5 |
25% | n/a | P | $2,662.18 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$20.60 |
$435 | No | 5 |
Tier 5 |
25% | n/a | P | $2,662.18 |
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 | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,445.18 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.90 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,463.74 |
Browse Plan Formulary |
WellCare Extra Smile (HMO-POS D-SNP)
|
$23.30 |
$435 | No | 5 |
Tier 5 |
25% | n/a | P | $2,662.18 |
Browse Plan Formulary |
Align Thrive (HMO I-SNP)
|
$30.20 |
$435 | No | 1 |
Tier 1 |
25% | n/a | None | $2,524.66 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.20 |
$435 | No | 5 |
Tier 5 |
25% | n/a | P | $2,458.04 |
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 D-SNP (HMO D-SNP)
|
$30.20 |
$435 | No | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /30Days | $2,466.82 |
Browse Plan Formulary |
UnitedHealthcare Dual Complete (HMO D-SNP)
|
$30.20 |
$435 | No | 5 |
Tier 5 |
$0.00 | $0.00 | P Q:2 /30Days | $2,680.80 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$32.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | $2,547.52 |
Browse Plan Formulary |
Cardinal (HMO)
|
$40.00 |
$0 | No | 5 |
Tier 5 |
30% | n/a | P | $2,556.30 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,449.92 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,450.52 |
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 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 | No | 5 |
Tier 5 |
31% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
WellCare Elite (HMO-POS)
|
$47.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P | n/a |
Browse Plan Formulary |
BCN Advantage HMO ConnectedCare (HMO)
|
$56.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,463.74 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (PPO)
|
$56.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
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 (HMO-POS)
|
$76.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,450.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.02 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,416.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,437.54 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,468.06 |
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 Merit (PPO)
|
$85.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,451.18 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,449.24 |
Browse Plan Formulary |
HAP Senior Plus Henry Ford Tiered Access (HMO)
|
$91.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,463.90 |
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 /30Days | $2,449.92 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,450.52 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,437.76 |
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)
|
$128.30 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,434.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,416.32 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,453.66 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,468.06 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,450.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,434.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,416.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,437.54 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $126.00 | None | $2,468.06 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$149.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$181.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,451.18 |
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 /30Days | $2,449.24 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,476.28 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,483.74 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 | No | 5 |
Tier 5 |
33% | n/a | P Q:2 /30Days | $2,486.92 |
Browse Plan Formulary |
HAP Senior Plus Option 4 (PPO)
|
$200.00 |
$0 | No | 3 |
Tier 3 |
$42.00 | $105.00 | S | $2,470.64 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,437.76 |
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)
|
$263.00 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,434.02 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,416.32 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,453.66 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 | No | 3 |
Tier 3 |
$38.00 | $114.00 | None | $2,468.06 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 | No | 3 |
Tier 3 |
$37.00 | $111.00 | None | $2,450.38 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 | No | 3 |
Tier 3 |
$37.00 | $111.00 | None | $2,434.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Additional Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 | No | 3 |
Tier 3 |
$37.00 | $111.00 | None | $2,416.72 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 | No | 3 |
Tier 3 |
$37.00 | $111.00 | None | $2,437.54 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 | No | 3 |
Tier 3 |
$37.00 | $111.00 | None | $2,468.06 |
Browse Plan Formulary |