MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Ashland |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Carroll |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Columbiana |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Cuyahoga |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Geauga |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Holmes |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Lake |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Lorain |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Mahoning |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Medina |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Portage |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Stark |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Summit |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Trumbull |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Tuscarawas |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-1
Benefits & Contact Info
|
Wayne |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Adams |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Allen |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Auglaize |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Champaign |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Clinton |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Coshocton |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Crawford |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Darke |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Defiance |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Erie |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Fayette |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Gallia |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Guernsey |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Hardin |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Harrison |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Henry |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Highland |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Huron |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Jackson |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Knox |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Logan |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Mercer |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
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MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Monroe |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Noble |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Ottawa |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Paulding |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Pike |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Preble |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Putnam |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Richland |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Ross |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Sandusky |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Scioto |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Shelby |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Van Wert |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Vinton |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Washington |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-2
Benefits & Contact Info
|
Williams |
$127.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Brown |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Butler |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Clark |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Clermont |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Delaware |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Fairfield |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Franklin |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Fulton |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Greene |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Hamilton |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Hancock |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Hocking |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Licking |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Lucas |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Madison |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Marion |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Miami |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Montgomery |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Morgan |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Morrow |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Muskingum |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Perry |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Pickaway |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Seneca |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Union |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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|
Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Warren |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
|
|
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Higher cost-sharing at standard network pharmacies. Details:
|
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Wood |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 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 |
MedMutual Advantage Plus (HMO) in OH - H6723-003-3
Benefits & Contact Info
|
Wyandot |
$90.00 |
$55 Tier 1 and 2 exempt |
Yes, some additional gap coverage. | Preferred Generic: $0.00 Generic: $5.00 Preferred Brand: $42.00 Non-Preferred Drug: 50% Specialty Tier: 32%
all covered insulin pay $35 or less | $3,450 Browse Formulary |
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Higher cost-sharing at standard network pharmacies. Details:
|