FYCOMPA 8 MG TABLET (30 EA ) (NDC: 62856027830)
2021 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 Premier (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,108.50 |
Browse Plan Formulary |
Aetna Medicare Value (PPO)
|
$0.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,108.50 |
Browse Plan Formulary |
BCN Advantage Prime Value (HMO-POS)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | None | $1,073.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | None | $1,038.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | None | $1,052.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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 Prime Value (HMO-POS)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | None | $1,022.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage Prime Value (HMO-POS)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | None | $1,031.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HAP Senior Plus (HMO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus Option 1 (PPO)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,047.30 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,073.10 |
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)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,022.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,033.20 |
Browse Plan Formulary |
Medicare Plus Blue PPO Essential (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,038.90 |
Browse Plan Formulary |
Paramount Elite - Standard Medical & Drug (HMO)
|
$0.00 |
$50 | No | 5 |
Specialty Tier |
32% | n/a | P Q:30 /30Days | $1,024.50 |
Browse Plan Formulary |
PriorityMedicare Compass (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary |
PriorityMedicare Compass (PPO)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,017.30 |
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 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,017.30 |
Browse Plan Formulary |
PriorityMedicare Key (HMO-POS)
|
$0.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary |
Reliance Principle Plan (HMO)
|
$0.00 |
$125 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $1,050.30 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
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 |
WellCare Dividend (HMO)
|
$0.00 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,112.40 |
Browse Plan Formulary |
WellCare Essential (HMO-POS)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,112.40 |
Browse Plan Formulary |
WellCare Explore (HMO-POS)
|
$0.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,112.40 |
Browse Plan Formulary |
WellCare Elite Smile (HMO-POS)
|
$14.10 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,112.70 |
Browse Plan Formulary |
HumanaChoice H8087-001 (PPO)
|
$20.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | P Q:30 /30Days | $1,109.10 |
Browse Plan Formulary |
Humana Value Plus H8087-002 (PPO)
|
$22.50 |
$260 | No | 5 |
Specialty Tier |
28% | n/a | P Q:30 /30Days | $1,107.90 |
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 Ideal (PPO)
|
$25.00 |
$125 | No | 5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 | No | 5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 | No | 5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 | No | 5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,017.30 |
Browse Plan Formulary |
PriorityMedicare Ideal (PPO)
|
$25.00 |
$125 | No | 5 |
Specialty Tier |
30% | n/a | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary |
Paramount Elite - Prime Medical & Drug (HMO)
|
$28.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,024.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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 SNP-DE H8087-003 (PPO D-SNP)
|
$28.70 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,105.50 |
Browse Plan Formulary |
Longevity Health Plan (HMO I-SNP)
|
$30.10 |
$445 | No | 1 |
Tier 1 |
25% | n/a | P | $1,050.00 |
Browse Plan Formulary |
Molina Medicare Complete Care (HMO D-SNP)
|
$30.10 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,024.50 |
Browse Plan Formulary |
PriorityMedicare D-SNP (HMO D-SNP)
|
$30.10 |
$445 | No | 5 |
Tier 5 |
$0.00 | $0.00 | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary |
WellCare Extra Plus (HMO-POS D-SNP)
|
$30.10 |
$445 | No | 5 |
Specialty Tier |
25% | n/a | P Q:30 /30Days | $1,112.70 |
Browse Plan Formulary |
HumanaChoice R3887-002 (Regional PPO)
|
$32.40 |
$380 | No | 5 |
Specialty Tier |
26% | n/a | P Q:30 /30Days | $1,109.10 |
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 |
Aetna Medicare Premier Plus (PPO)
|
$34.00 |
$0 | Yes, but No Gap Coverage for this drug. | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,108.50 |
Browse Plan Formulary |
Reliance Cardinal Plan (HMO)
|
$40.00 |
$0 | No | 4 |
Non-Preferred Drug |
$100.00 | $300.00 | None | $1,050.30 |
Browse Plan Formulary select insulin pay $10 copay but not this drug |
WellCare Elite (HMO-POS)
|
$47.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,112.70 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (PPO)
|
$60.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
Paramount Elite - Enhanced Medical & Drug (HMO)
|
$68.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,024.50 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
HumanaChoice H5216-009 (PPO)
|
$70.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P Q:30 /30Days | $1,105.50 |
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 |
Medicare Plus Blue PPO Vitality (PPO)
|
$70.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,038.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$70.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,047.30 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$70.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,073.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$70.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,022.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Vitality (PPO)
|
$70.00 |
$100 | No | 5 |
Specialty Tier |
31% | n/a | None | $1,033.20 |
Browse Plan Formulary |
PriorityMedicare Value (HMO-POS)
|
$73.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
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)
|
$73.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
|
$73.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,017.30 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
|
$73.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Value (HMO-POS)
|
$73.00 |
$75 | No | 5 |
Specialty Tier |
31% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
HAP Senior Plus Option 1 (HMO-POS)
|
$85.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Merit (PPO)
|
$100.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,017.30 |
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)
|
$100.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$100.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$100.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary |
PriorityMedicare Merit (PPO)
|
$100.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$112.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,031.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$112.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,038.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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)
|
$112.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,022.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$112.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,073.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Classic (HMO-POS)
|
$112.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,052.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Signature (PPO)
|
$152.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,073.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$152.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,047.30 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$152.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,038.90 |
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 |
Medicare Plus Blue PPO Signature (PPO)
|
$152.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,022.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Signature (PPO)
|
$152.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,033.20 |
Browse Plan Formulary |
HAP Senior Plus Option 3 (PPO)
|
$160.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare (HMO-POS)
|
$170.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$170.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$170.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,047.00 |
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 |
PriorityMedicare (HMO-POS)
|
$170.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,017.30 |
Browse Plan Formulary |
PriorityMedicare (HMO-POS)
|
$170.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $989.10 |
Browse Plan Formulary |
HAP Senior Plus Option 2 (HMO-POS)
|
$190.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
PriorityMedicare Select (PPO)
|
$199.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $999.90 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$199.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,060.20 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$199.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $989.10 |
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)
|
$199.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,017.30 |
Browse Plan Formulary |
PriorityMedicare Select (PPO)
|
$199.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | Q:30 /30Days | $1,047.00 |
Browse Plan Formulary |
HAP Senior Plus Option 4 (PPO)
|
$200.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | P | $1,041.60 |
Browse Plan Formulary select insulin pay $15-$35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$249.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,052.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$249.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,073.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$249.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,031.40 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
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)
|
$249.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,022.10 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
BCN Advantage HMO-POS Prestige (HMO-POS)
|
$249.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,038.90 |
Browse Plan Formulary select insulin pay $35 copay but not this drug |
Medicare Plus Blue PPO Assure (PPO)
|
$257.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,038.90 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$257.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,047.30 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$257.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,073.10 |
Browse Plan Formulary |
Medicare Plus Blue PPO Assure (PPO)
|
$257.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,022.10 |
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)
|
$257.00 |
$0 | No | 5 |
Specialty Tier |
33% | n/a | None | $1,033.20 |
Browse Plan Formulary |