Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Albemarle |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Amelia |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Amherst |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Augusta |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Bedford |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Botetourt |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Brunswick |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Campbell |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Caroline |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Chesterfield |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Culpeper |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Dinwiddie |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Fauquier |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Floyd |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Franklin |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Frederick |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Giles |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Goochland |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Greensville |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Halifax |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Hanover |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Henrico |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Henry |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Lunenburg |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Mecklenburg |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Montgomery |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Nottoway |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Orange |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Pittsylvania |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Powhatan |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Prince Edward |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Prince George |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Pulaski |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Roanoke |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Rockbridge |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Rockingham |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Shenandoah |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Spotsylvania |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Stafford |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Tazewell |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Washington |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Wise |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Wythe |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Bristol City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Buena Vista City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Charlottesville City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Colonial Heights City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Danville City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Emporia City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Fredericksburg City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Harrisonburg City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Hopewell City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Lexington City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Lynchburg City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Martinsville City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Petersburg City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Richmond City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Roanoke City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Staunton City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Waynesboro City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 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 |
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Winchester City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Radford City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem MediBlue Extra (HMO) in VA - H3447-027-0
Benefit Details
|
Salem City |
$25.90 |
$505 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $16.00 Preferred Brand: $47.00 Non-Preferred Drug: $95.00 Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,400 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|