Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Anderson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Bedford |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Benton |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Bledsoe |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Blount |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Bradley |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Campbell |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Cannon |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Carroll |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Carter |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Cheatham |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Chester |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Claiborne |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Clay |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Cocke |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Coffee |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Crockett |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Cumberland |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Davidson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Decatur |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
DeKalb |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Dickson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Dyer |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Fayette |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Fentress |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Franklin |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Gibson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Giles |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Grainger |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Greene |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Grundy |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hamblen |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hamilton |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hancock |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hardeman |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hardin |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hawkins |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Haywood |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Henderson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Henry |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Hickman |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Houston |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Humphreys |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Jackson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Jefferson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Johnson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Knox |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Lake |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Lauderdale |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Lawrence |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Lewis |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Lincoln |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Loudon |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
McMinn |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
McNairy |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Macon |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Madison |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Marion |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Marshall |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Maury |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Meigs |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Monroe |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Montgomery |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Moore |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Morgan |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Obion |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Overton |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Perry |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Pickett |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Polk |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Putnam |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Rhea |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Roane |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Robertson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Rutherford |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Scott |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Sequatchie |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Sevier |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Shelby |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Smith |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Stewart |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Sullivan |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Sumner |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Tipton |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Trousdale |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Unicoi |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Union |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Van Buren |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Warren |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Washington |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Wayne |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Weakley |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
White |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Plan Name |
County |
Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
Service |
Exper. |
Cost Info |
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Williamson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|
Wellpoint Extra Help (HMO) in TN - H5828-008-0
Benefits & Contact Info
|
Wilson |
$8.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $10.00 Generic: $20.00 Preferred Brand: $37.00 Non-Preferred Drug: $90.00 Specialty Tier: 25% Select Care Drugs: $10.00
all covered insulin pay $35 or less | $4,900 Browse Formulary |
|
|
|
Higher cost-sharing at standard network pharmacies. Details:
|