Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Aitkin |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Carlton |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Cook |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Goodhue |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Itasca |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Kanabec |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Koochiching |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Lake |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Le Sueur |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
McLeod |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Meeker |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Mille Lacs |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Pine |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Pipestone |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Rice |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Rock |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
St. Louis |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Sibley |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Stevens |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Traverse |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in MN - H2450-049-0
Benefits & Contact Info
|
Yellow Medicine |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Adams |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Barnes |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Benson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Billings |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Bowman |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Cass |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Cavalier |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Dickey |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Dunn |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Eddy |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Emmons |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Foster |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Grant |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Griggs |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Hettinger |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Kidder |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
LaMoure |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Logan |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
McHenry |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
McIntosh |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
McLean |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Mercer |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Nelson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Oliver |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Pembina |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Pierce |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Ramsey |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Ransom |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Richland |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Rolette |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Sargent |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Sheridan |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Sioux |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Slope |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Stark |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Steele |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Towner |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Traill |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Walsh |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Ward |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Wells |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in ND - H2450-049-0
Benefits & Contact Info
|
Williams |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Aurora |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Beadle |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Bennett |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Bon Homme |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Brown |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Brule |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Buffalo |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Butte |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Campbell |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Charles Mix |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Clark |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Clay |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Codington |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Corson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Custer |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Davison |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Day |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Dewey |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Douglas |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Edmunds |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Fall River |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Faulk |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Grant |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Gregory |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Haakon |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Hand |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Hanson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Harding |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Hughes |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Hutchinson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Hyde |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Jackson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Jerauld |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Jones |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Kingsbury |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Lake |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Lawrence |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Lincoln |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Lyman |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
-- |
|
|
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
McCook |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
McPherson |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Marshall |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Meade |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Mellette |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Miner |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Minnehaha |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Moody |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Oglala Lakota |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Pennington |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Perkins |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Potter |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Roberts |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Sanborn |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Spink |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Stanley |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Sully |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Todd |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Tripp |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Turner |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Union |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Walworth |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Yankton |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in SD - H2450-049-0
Benefits & Contact Info
|
Ziebach |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Albany |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Campbell |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Crook |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Goshen |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Laramie |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Niobrara |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Platte |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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Medica Prime Solution Standard w/Rx (Cost) in WY - H2450-049-0
Benefits & Contact Info
|
Weston |
$49.30 |
$0 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $47.00 Non-Preferred Drug: 50% Specialty Tier: 33%
all covered insulin pay $35 or less | $5,000 Browse Formulary |
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