Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Adams |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Ashland |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Barron |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Bayfield |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Brown |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Buffalo |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Burnett |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Chippewa |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Clark |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Columbia |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Crawford |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Dane |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Door |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Douglas |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Dunn |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Eau Claire |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Florence |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Forest |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Green |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Green Lake |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Iowa |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Iron |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Jackson |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Jefferson |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Juneau |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Kewaunee |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
La Crosse |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Langlade |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Lincoln |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Marathon |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Marinette |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Marquette |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Monroe |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Oconto |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Oneida |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Outagamie |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Pepin |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Pierce |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Polk |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Portage |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Price |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Richland |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Rusk |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Sauk |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Sawyer |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Shawano |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Taylor |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Trempealeau |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Vernon |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Vilas |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Washburn |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Waukesha |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Waupaca |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Waushara |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 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 |
Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Winnebago |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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Ascend Rx (HMO-POS) in WI - H5211-013-0
Benefits & Contact Info
|
Wood |
$53.00 |
$330 Tier 1, 2 and 6 exempt |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Generic: $9.00 Preferred Brand: $47.00 Non-Preferred Drug: $100.00 Specialty Tier: 26% Vaccines ($0 cost sharing): $0.00
all covered insulin pay $35 or less | $4,500 Browse Formulary |
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