Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Anderson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Bedford |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Benton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Bledsoe |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Blount |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Bradley |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Campbell |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Cannon |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Carroll |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Cheatham |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Claiborne |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Clay |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Cocke |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Coffee |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Cumberland |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Davidson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Decatur |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
DeKalb |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Dickson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Fayette |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Fentress |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Franklin |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Giles |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Grainger |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Grundy |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Hamblen |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Hamilton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Hancock |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Hardeman |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% 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 TN - H9428-001-0
Benefit Details
|
Haywood |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Hickman |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Houston |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Humphreys |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Jackson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Jefferson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Knox |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Lawrence |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Lewis |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Lincoln |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Loudon |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Macon |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Marion |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Marshall |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Maury |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Meigs |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Monroe |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Montgomery |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Moore |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Morgan |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Overton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Perry |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Pickett |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Polk |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Putnam |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Rhea |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Roane |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Robertson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Rutherford |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Scott |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Sequatchie |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Sevier |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Shelby |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Smith |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Stewart |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Sumner |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Trousdale |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Union |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Van Buren |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Warren |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Wayne |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
White |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium Open (PPO) in TN - H9428-001-0
Benefit Details
|
Williamson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
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 TN - H9428-001-0
Benefit Details
|
Wilson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $10.00 Preferred Brand: $37.00 Non-Preferred Drug: 48% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $5,500 Browse Formulary |
|
-- |
|
Higher cost-sharing at standard network pharmacies. Details:
|