Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Adams |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Antelope |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Banner |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Blaine |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Boone |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Boyd |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Buffalo |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Burt |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Butler |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Cass |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Cedar |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Clay |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Colfax |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Cuming |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Custer |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Dawson |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Dixon |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Dodge |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Douglas |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Fillmore |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Franklin |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Frontier |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Furnas |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Gage |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Garfield |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Gosper |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Greeley |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Hall |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Hamilton |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Harlan |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Hayes |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Hitchcock |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Holt |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Howard |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Jefferson |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Johnson |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Kearney |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Keith |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Knox |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Lancaster |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Lincoln |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Logan |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Madison |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Merrick |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Nance |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Nemaha |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Otoe |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Pawnee |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Perkins |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Phelps |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Pierce |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Polk |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Saline |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Sarpy |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Saunders |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Scotts Bluff |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Seward |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Sherman |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Stanton |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Thayer |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Valley |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Washington |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Wayne |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Webster |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
Wheeler |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Wellcare Assist Open (PPO) in NE - H1395-003-0
Benefits & Contact Info
|
York |
$24.70 |
$440 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: 48% Specialty Tier: 25% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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