Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Adams |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Allen |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Ashland |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Athens |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Auglaize |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Belmont |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Brown |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Butler |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Carroll |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Champaign |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Clark |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Clermont |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Clinton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Columbiana |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Coshocton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Crawford |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Cuyahoga |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Darke |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Defiance |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Delaware |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Erie |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Fairfield |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Fayette |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Franklin |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Fulton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Gallia |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Geauga |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Greene |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Guernsey |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Hamilton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Hancock |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Hardin |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Harrison |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Henry |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Highland |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Hocking |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Holmes |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Huron |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Jackson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Jefferson |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Knox |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Lake |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Lawrence |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Licking |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Logan |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Lorain |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Lucas |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Madison |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Mahoning |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Marion |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Medina |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Meigs |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Mercer |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Miami |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Monroe |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Montgomery |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Morgan |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Morrow |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Muskingum |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Noble |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Ottawa |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Paulding |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Perry |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Pickaway |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Pike |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Portage |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Preble |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Putnam |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Richland |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Ross |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Sandusky |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Scioto |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Seneca |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Shelby |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Stark |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Summit |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Trumbull |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Tuscarawas |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Union |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Van Wert |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Vinton |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Warren |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Washington |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Wayne |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 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 (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Williams |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Wood |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare No Premium (HMO) in OH - H0908-003-0
Benefits & Contact Info
|
Wyandot |
$0.00 |
$75 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $9.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 31% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|