OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG (1.5 ML CTG) (NDC: 00781300107)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.80 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Complete (PPO)
|
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.71 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-089 (HMO)
|
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
33% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-269 (PPO)
|
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $836.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $816.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $836.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $816.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $836.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $816.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $836.81 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-142 (PPO)
|
$7.00 |
$250 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
29% | n/a | P | $816.97 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-368 (PPO)
|
$7.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H5619-093 (HMO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
15% | 15% | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Value Plus H5216-179 (PPO)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice SNP-DE H5216-370 (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
$0.00 | $0.00 | P | $797.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO D-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage (PPO I-SNP)
|
$41.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | 25% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R7315-002 (Regional PPO)
|
$75.00 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
25% | n/a | P | $790.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Simpra Advantage Premier (PPO I-SNP)
|
$98.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
5 |
Tier 5 |
30% | 30% | P | $1,289.39 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |
Blue Advantage Premier (PPO)
|
$159.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$40.00 | $80.00 | P | $811.74 |
Browse Plan Formulary all covered insulin pay $35 or less |