HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Atchison |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Bourbon |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Butler |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Cowley |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Dickinson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Douglas |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Franklin |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Geary |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Harvey |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Jefferson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Johnson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Leavenworth |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Linn |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
McPherson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Miami |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Pottawatomie |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Reno |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Sedgwick |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Shawnee |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Sumner |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in KS - H5216-033-1
Benefit Details
|
Wyandotte |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Barry |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Barton |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Bates |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Benton |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Bollinger |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Camden |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Carroll |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Cass |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Cedar |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Clay |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Cooper |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Crawford |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Dade |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Dallas |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Douglas |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Henry |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Hickory |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Howard |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Howell |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Jackson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Johnson |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Laclede |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Lafayette |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Lawrence |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Lincoln |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Montgomery |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
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|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Oregon |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Ozark |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Pettis |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Phelps |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Platte |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Polk |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Pulaski |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Ray |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
St. Clair |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Saline |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Stone |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Taney |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Vernon |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-1
Benefit Details
|
Wright |
$34.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $5,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Bond |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Calhoun |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Clinton |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Jersey |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Macoupin |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Madison |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
Monroe |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in IL - H5216-033-2
Benefit Details
|
St. Clair |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Audrain |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Boone |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Butler |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Callaway |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Christian |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Cole |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Dunklin |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Gasconade |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Greene |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Jasper |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Jefferson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Maries |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Marion |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Miller |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Moniteau |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Morgan |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Newton |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Osage |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Perry |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Pike |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
St. Charles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Ste. Genevieve |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
St. Francois |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
St. Louis |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Stoddard |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Warren |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Washington |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 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 |
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
Webster |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
HumanaChoice H5216-033 (PPO) in MO - H5216-033-2
Benefit Details
|
St. Louis City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $7.00 Generic: $14.00 Preferred Brand: $47.00 Non-Preferred Drug: $99.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,600 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|