Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Adams |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Antelope |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Banner |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Blaine |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Boone |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Boyd |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Buffalo |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Burt |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Butler |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Cass |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Cedar |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Clay |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Colfax |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Cuming |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Custer |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Dawson |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Dixon |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Dodge |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Douglas |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Fillmore |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Franklin |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Frontier |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Furnas |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Gage |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Garfield |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Gosper |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Greeley |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Hall |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Hamilton |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Harlan |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Hayes |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Hitchcock |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Holt |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Howard |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Jefferson |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Johnson |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Kearney |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Keith |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Knox |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Lancaster |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Lincoln |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Logan |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Madison |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Merrick |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Nance |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Nemaha |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Otoe |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Pawnee |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Perkins |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Phelps |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Pierce |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Polk |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Saline |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Sarpy |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Saunders |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Scotts Bluff |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Seward |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Sherman |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Stanton |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Thayer |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Valley |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Washington |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Wayne |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
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 |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Webster |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
Wheeler |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefit Details
|
York |
$12.60 |
$505 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 47% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
|
new |
new |
Higher cost-sharing at standard network pharmacies. Details:
|