BRIVIACT 100 MG TABLET (60 EA ) (NDC: 50474077066)
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 | $1,194.00 |
Browse Plan Formulary |
Aetna Medicare Premier (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $1,193.40 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$150 |
No |
5 |
Tier 5 |
30% | n/a | P | $1,192.80 |
Browse Plan Formulary |
Align Connect (HMO C-SNP)
|
$0.00 |
$435 |
No |
4 |
Tier 4 |
$95.00 | n/a | P Q:60 /30Days | $1,182.00 |
Browse Plan Formulary |
AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | S | $1,158.00 |
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 |
5 |
Tier 5 |
28% | n/a | P Q:62 /31Days | $1,129.20 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | P Q:62 /31Days | $1,153.20 |
Browse Plan Formulary |
BCN Advantage HMO HealthyValue (HMO)
|
$0.00 |
$250 |
No |
5 |
Tier 5 |
28% | n/a | P Q:62 /31Days | $1,129.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,147.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,149.60 |
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:62 /31Days | $1,136.40 |
Browse Plan Formulary |
BCN Advantage HMO-POS Basic (HMO-POS)
|
$0.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
HAP Empowered MI Health Link (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | None | $1,150.80 |
Browse Plan Formulary |
HAP Primary Choice Medicare (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
HAP Senior Plus (HMO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
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 |
Humana Gold Plus H8908-004 (HMO)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:60 /30Days | $1,238.40 |
Browse Plan Formulary |
Michigan Complete Health (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,164.60 |
Browse Plan Formulary |
Molina Dual Options (Medicare-Medicaid Plan)
|
$0.00 |
$0 |
No |
2 |
Tier 2 |
0% | 0% | P | $1,149.60 |
Browse Plan Formulary |
Principle (HMO)
|
$0.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | P | $1,160.40 |
Browse Plan Formulary |
PriorityMedicare Edge (PPO)
|
$0.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,158.60 |
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 | S Q:60 /30Days | $1,162.80 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,154.40 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,165.20 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,171.20 |
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 |
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 |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,134.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,147.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$9.00 |
$200 |
No |
5 |
Tier 5 |
29% | n/a | P Q:62 /31Days | $1,129.80 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,164.60 |
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 | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,158.60 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,162.80 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$14.00 |
$125 |
No |
5 |
Tier 5 |
30% | n/a | S Q:60 /30Days | $1,154.40 |
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 | $1,245.60 |
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 |
Humana Gold Plus SNP-DE H8908-005 (HMO D-SNP)
|
$20.20 |
$425 |
No |
5 |
Tier 5 |
25% | n/a | P Q:60 /30Days | $1,238.40 |
Browse Plan Formulary |
WellCare Plus (HMO)
|
$20.60 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $1,245.60 |
Browse Plan Formulary |
HumanaChoice H5216-133 (PPO)
|
$21.00 |
$270 |
No |
5 |
Tier 5 |
28% | n/a | P Q:60 /30Days | $1,238.40 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,153.20 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,129.80 |
Browse Plan Formulary |
BCN Advantage HMO HealthySaver (HMO)
|
$23.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,129.20 |
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 R3887-002 (Regional PPO)
|
$23.00 |
$210 |
No |
5 |
Tier 5 |
29% | n/a | P Q:60 /30Days | $1,237.80 |
Browse Plan Formulary |
WellCare Extra Smile (HMO-POS D-SNP)
|
$23.30 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $1,245.60 |
Browse Plan Formulary |
Align Thrive (HMO I-SNP)
|
$30.20 |
$435 |
No |
1 |
Tier 1 |
25% | n/a | P Q:60 /30Days | $1,182.00 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.20 |
$435 |
No |
5 |
Tier 5 |
25% | n/a | P | $1,149.60 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
|
$30.20 |
$435 |
No |
5 |
Tier 5 |
$0.00 | $0.00 | S Q:60 /30Days | $1,168.20 |
Browse Plan Formulary |
Aetna Medicare Premier Plus (PPO)
|
$32.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P | $1,192.80 |
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 |
Cardinal (HMO)
|
$40.00 |
$0 |
No |
5 |
Tier 5 |
30% | n/a | P | $1,160.40 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,162.80 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,154.40 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,165.20 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$42.00 |
$75 |
No |
5 |
Tier 5 |
31% | n/a | S Q:60 /30Days | $1,158.60 |
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 |
Humana Gold Plus H8908-001 (HMO)
|
$44.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:60 /30Days | $1,238.40 |
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 |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,129.20 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (PPO)
|
$56.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
HAP Senior Plus Option 1 (HMO-POS)
|
$76.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,129.80 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,134.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,147.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$76.00 |
$100 |
No |
5 |
Tier 5 |
31% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,158.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,162.80 |
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 |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,154.40 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,164.60 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$85.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
HAP Senior Plus Henry Ford Tiered Access (HMO)
|
$91.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,151.40 |
Browse Plan Formulary |
HumanaChoice H5216-011 (PPO)
|
$98.00 |
$105 |
No |
5 |
Tier 5 |
31% | n/a | P Q:60 /30Days | $1,238.40 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,162.80 |
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 |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,154.40 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,165.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$113.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,158.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
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-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,147.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$128.30 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,136.40 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,129.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,134.60 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$134.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,147.20 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$149.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$181.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,154.40 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,164.60 |
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 | S Q:60 /30Days | $1,171.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,158.60 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$196.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | S Q:60 /30Days | $1,162.80 |
Browse Plan Formulary |
HAP Senior Plus Option 4 (PPO)
|
$200.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | None | $1,153.20 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,147.80 |
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-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,136.40 |
Browse Plan Formulary |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$263.00 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,129.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,126.80 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,134.60 |
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 |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,147.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$298.10 |
$0 |
No |
5 |
Tier 5 |
33% | n/a | P Q:62 /31Days | $1,149.60 |
Browse Plan Formulary |