Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Anson |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Avery |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Buncombe |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Caswell |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Catawba |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Cherokee |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Davidson |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Davie |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Forsyth |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Gaston |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Gates |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Henderson |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Madison |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Mecklenburg |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Rowan |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Scotland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Watauga |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in NC - H8145-004-0
Benefit Details
|
Yancey |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Amherst |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Appomattox |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Bath |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Bedford |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Bland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Botetourt |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Brunswick |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Carroll |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Chesterfield |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Craig |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Essex |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Floyd |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Gloucester |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Goochland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Greensville |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Halifax |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Hanover |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Henrico |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Highland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Isle of Wight |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
King George |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Lancaster |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Loudoun |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Mecklenburg |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Middlesex |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Northampton |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Northumberland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Nottoway |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Page |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Patrick |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Pittsylvania |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Powhatan |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Prince Edward |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Pulaski |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Rappahannock |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Richmond |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Roanoke |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Rockingham |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Southampton |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Spotsylvania |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Stafford |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Westmoreland |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
York |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Alexandria City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Chesapeake City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Emporia City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Falls Church City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Fredericksburg City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Galax City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Hampton City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Harrisonburg City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Newport News City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Norfolk City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Petersburg City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Portsmouth City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Richmond City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Roanoke City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Suffolk City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Virginia Beach City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Williamsburg City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| 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 H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Radford City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Humana Gold Choice H8145-004 (PFFS) in VA - H8145-004-0
Benefit Details
|
Salem City |
$86.00 |
$160 Tier 1 and 2 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 30%
| n/a Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|