Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Abbeville |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Aiken |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Allendale |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Anderson |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Bamberg |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Barnwell |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Beaufort |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Berkeley |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Calhoun |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Charleston |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Cherokee |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Chester |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Chesterfield |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Clarendon |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Colleton |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Darlington |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Dillon |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Dorchester |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Edgefield |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Fairfield |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Florence |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Georgetown |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Greenville |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Greenwood |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Hampton |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Horry |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Jasper |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Kershaw |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Lancaster |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Laurens |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Lee |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Lexington |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
McCormick |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Marion |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Marlboro |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Newberry |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Oconee |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Orangeburg |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Pickens |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Richland |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Saluda |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Spartanburg |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Sumter |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Union |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
Williamsburg |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 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 |
Wellcare No Premium Open (PPO) in SC - H7326-001-0
Benefit Details
|
York |
$0.00 |
$100 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $0.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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