Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Appling |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Atkinson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Bacon |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Baker |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Baldwin |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Banks |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Barrow |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Bartow |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Ben Hill |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Berrien |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Bibb |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Bleckley |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Brantley |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Brooks |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Bryan |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Burke |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Butts |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Camden |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Candler |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Carroll |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Catoosa |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Charlton |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Chatham |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Chattahoochee |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Chattooga |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Cherokee |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Clarke |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Clayton |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Clinch |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Cobb |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Coffee |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Colquitt |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Columbia |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Cook |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Coweta |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Crawford |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Crisp |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Dade |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Dawson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Decatur |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
DeKalb |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Dodge |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Dooly |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Douglas |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Echols |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Effingham |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Elbert |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Emanuel |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Evans |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Fannin |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Fayette |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Floyd |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Forsyth |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Franklin |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Fulton |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Gilmer |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Glascock |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Glynn |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Gordon |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Grady |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Greene |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Gwinnett |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Habersham |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Hall |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Hancock |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Haralson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Harris |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Hart |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Heard |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Henry |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Houston |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Irwin |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jackson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jasper |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jeff Davis |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jefferson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jenkins |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Johnson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Jones |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Lamar |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Lanier |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Laurens |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Liberty |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Lincoln |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Long |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Lowndes |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Lumpkin |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
McDuffie |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
McIntosh |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Macon |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Madison |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Marion |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Meriwether |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Miller |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Mitchell |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Monroe |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Montgomery |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Morgan |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Murray |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Muscogee |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Newton |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Oconee |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Oglethorpe |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Paulding |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Peach |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Pickens |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Pierce |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Pike |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Polk |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Pulaski |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Putnam |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Quitman |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Rabun |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Randolph |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Richmond |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Rockdale |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Schley |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Screven |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Seminole |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Spalding |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Stephens |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Stewart |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Talbot |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Taliaferro |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Tattnall |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Taylor |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Telfair |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Thomas |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Tift |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Toombs |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Towns |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Treutlen |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Troup |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Turner |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
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Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Twiggs |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Union |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Upson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Walker |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Walton |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Ware |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Warren |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Washington |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Wayne |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Webster |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Wheeler |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
White |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Whitfield |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Wilcox |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Wilkes |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Wilkinson |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 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 Assist (HMO) in GA - H1112-043-0
Benefits & Contact Info
|
Worth |
$35.00 |
$410 Tier 1 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $20.00 Preferred Brand: $47.00 Non-Preferred Drug: 45% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $3,650 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|