Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Alleghany |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Amelia |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Appomattox |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Augusta |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Bath |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Caroline |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Charles City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Chesterfield |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Clarke |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Craig |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Cumberland |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Dinwiddie |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Essex |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Franklin |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Giles |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Gloucester |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Goochland |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Greene |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Greensville |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Halifax |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Hanover |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Henrico |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Highland |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Isle of Wight |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
King and Queen |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
King William |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Lunenburg |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Madison |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Mathews |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Mecklenburg |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Montgomery |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Nelson |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
New Kent |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Nottoway |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Pittsylvania |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Powhatan |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Prince George |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Pulaski |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Rappahannock |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Richmond |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Roanoke |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Rockbridge |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Rockingham |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Southampton |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Surry |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Sussex |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Warren |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Buena Vista City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Colonial Heights City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Covington City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Danville City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Emporia City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Franklin City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Galax City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Harrisonburg City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Hopewell City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Lexington City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Petersburg City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Poquoson City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Richmond City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Roanoke City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Staunton City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Waynesboro City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
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 |
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Radford City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Clear Spring Health Essential (HMO) in VA - H8293-001-0
Benefit Details
|
Salem City |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 33%
select insulin pay $35 copay | $3,250 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|