Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Adams |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Amite |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Attala |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Bolivar |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Calhoun |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Carroll |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Choctaw |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Claiborne |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Clarke |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Coahoma |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Copiah |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Covington |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Franklin |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
George |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Greene |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Grenada |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Hancock |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Harrison |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Hinds |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Holmes |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Humphreys |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Issaquena |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Jackson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Jasper |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Jefferson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Jefferson Davis |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Jones |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Lawrence |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Leake |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Leflore |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Lincoln |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Madison |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Marion |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Montgomery |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Newton |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Panola |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Pearl River |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Perry |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Pike |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Quitman |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Rankin |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Scott |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Sharkey |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Simpson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Smith |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Stone |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Sunflower |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Tallahatchie |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Tunica |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Walthall |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Warren |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Wayne |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Webster |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Wilkinson |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 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 |
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Yalobusha |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Vantage Giveback (HMO-POS) in MS - H7163-005-0
Benefit Details
|
Yazoo |
$0.00 |
$505 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Brand: $100.00 Specialty Tier: 25%
all covered insulin pay $35 or less | $5,900 Browse Formulary |
|
new |
|
Higher cost-sharing at standard network pharmacies. Details:
|