Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Adams |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Ashland |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Barron |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Bayfield |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Brown |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Buffalo |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Burnett |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Calumet |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Chippewa |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Clark |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Columbia |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Crawford |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Dane |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Dodge |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Door |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Douglas |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Dunn |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Eau Claire |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Florence |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Fond du Lac |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Forest |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Grant |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Green |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Green Lake |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Iowa |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Iron |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Jackson |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Jefferson |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Juneau |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Kenosha |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Kewaunee |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
La Crosse |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Lafayette |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Langlade |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Lincoln |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Manitowoc |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Marathon |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Marinette |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Marquette |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Menominee |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Milwaukee |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Monroe |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Oconto |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Oneida |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Outagamie |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Ozaukee |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Pepin |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Pierce |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Polk |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Portage |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Price |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Racine |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Richland |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Rock |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Rusk |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
St. Croix |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Sauk |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Sawyer |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Shawano |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Sheboygan |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Taylor |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Trempealeau |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Vernon |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Vilas |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Walworth |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Washburn |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Washington |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Waukesha |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Waupaca |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Waushara |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Winnebago |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
Anthem Medicare Advantage (PPO) in WI - H4036-020-0
Benefits & Contact Info
|
Wood |
$0.00 |
$195 Tier 1, 2 and 6 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $15.00 Preferred Brand: $42.00 Non-Preferred Drug: $95.00 Specialty Tier: 30% Select Care Drugs: $0.00
all covered insulin pay $35 or less | $4,700 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|