Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Attala |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Bolivar |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Carroll |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Claiborne |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Clarke |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Coahoma |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Copiah |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Covington |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
DeSoto |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Forrest |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
George |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Greene |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Grenada |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Hancock |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Harrison |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Hinds |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Holmes |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Humphreys |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Issaquena |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Jackson |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Jasper |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Jefferson Davis |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Jones |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Kemper |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Lafayette |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Lamar |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Lauderdale |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Lawrence |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Leake |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Leflore |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Lincoln |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Madison |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Marion |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Marshall |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Montgomery |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Neshoba |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Newton |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Panola |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Perry |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Pike |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Quitman |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Rankin |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Scott |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Sharkey |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Simpson |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Smith |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Stone |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Sunflower |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Tallahatchie |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Tate |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Tunica |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Walthall |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Warren |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Washington |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 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 |
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Wayne |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Yalobusha |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Giveback (HMO) in MS - H1416-065-0
Benefit Details
|
Yazoo |
$0.00 |
$350 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $37.00 Non-Preferred Drug: $89.00 Specialty Tier: 27% Select Care Drugs: $0.00
| $6,700 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|