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2010 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible | (Donut Hole) Gap Coverage | Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
Members In This Plan ID | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Geisinger Gold Reserve 1 (MSA) - H8468-001-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 564 members | ||||||
Advantra Elite (PPO) - H5522-008-0 Benefit Details |
Lebanon | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $4.00 Tier 2 - Preferred Brand: $40.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $69.00 Tier 4 - Specialty Drugs: 33% | n/a Browse Formulary | |||||
Advantra Silver (HMO) - H3959-011-0 Benefit Details |
Lebanon | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generics: $6.00 Tier 2 - Preferred Brand: $32.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $64.00 Tier 4 - Specialty Drugs: 33% | 3,360 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Advantra Silver (PPO) - H5522-004-0 Benefit Details |
Lebanon | $0.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Preferred Brand: $37.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $69.00 Tier 4 - Specialty Drugs: 33% | 10,349 members Browse Formulary | |||||
Aetna Medicare Basic Plan (HMO) - H3931-054-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
CIGNA Medicare Access Plan One (PFFS) - H2762-020-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 13,290 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CIGNA Medicare Access Plus RX Plan Two (PFFS) - H2762-042-0 Benefit Details |
Lebanon | $0.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 40,257 members Browse Formulary | |||||
FreedomBlue PPO HD Rx (PPO) - H3916-025-0 Benefit Details |
Lebanon | $0.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 7,170 members Browse Formulary | |||||
Geisinger Gold Classic 3 (HMO) - H3954-098-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 438 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Open 3 (PFFS) - H5812-057-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 898 members | ||||||
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HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Statewide | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
HumanaChoice R5826-062 (Regional PPO) - R5826-062-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Plan 1 (PFFS) - H5435-001-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 27,113 members | ||||||
Today's Options Premier (PFFS) - H3333-104-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 247 members | ||||||
Today's Options Value (PFFS) - H3333-106-0 Benefit Details |
Lebanon | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | < 10 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Preferred (PPO) - H3924-021-0 Benefit Details |
Lebanon | $8.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 196 members | ||||||
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Any, Any, Any MA Only (PFFS) - H5820-026-0 Benefit Details |
Lebanon | $9.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 92 members | ||||||
Humana Gold Choice H2944-102 (PFFS) - H2944-102-0 Benefit Details |
Lebanon | $20.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 926 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Rx Plan 51 (PFFS) - H5435-014-0 Benefit Details |
Lebanon | $20.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $80.00 Tier 4 Specialty: 33% | 61,945 members Browse Formulary | |||||
Humana Gold Choice H2944-099 (PFFS) - H2944-099-0 Benefit Details |
Lebanon | $22.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | n/a Browse Formulary | |||||
Geisinger Gold Classic 2 (HMO) - H3954-013-0 Benefit Details |
Lebanon | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 78 members | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecureHorizons MedicareDirect Plan 100 (PFFS) - H5435-020-0 Benefit Details |
Lebanon | $25.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 4,121 members | ||||||
Today's Options Value powered by CCRx (PFFS) - H3333-107-0 Benefit Details |
Lebanon | $25.00 | $0 | No Gap Coverage | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 19 members Browse Formulary | |||||
Geisinger Gold Open 3 $0 Deductible Rx (PFFS) - H5812-044-0 Benefit Details |
Lebanon | $27.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Standard Plan (HMO) - H3931-070-0 Benefit Details |
Lebanon | $29.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $8.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | n/a Browse Formulary | |||||
Any, Any, Any Gold (PFFS) - H5820-002-0 Benefit Details |
Lebanon | $29.00 | $0 | No Gap Coverage | Value Generic: $4.00 Generic: $10.00 Preferred Brand: $35.00 Non Preferred Brand: $70.00 Speciality: 33% | 985 members Browse Formulary | |||||
Geisinger Gold Classic 3 Standard Rx (HMO) - H3954-099-0 Benefit Details |
Lebanon | $29.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 338 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Gateway Health Plan Medicare Assured (HMO) - H5932-001-0 Benefit Details |
Lebanon | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $94.75 Tier 4: 25% | 25,546 members Browse Formulary | |||||
Geisinger Gold Secure 1 (HMO) - H3954-097-0 Benefit Details |
Lebanon | $ for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No Gap Coverage | Tier 1: $0.00 Tier 2: $45.00 Tier 3: $95.00 Tier 4: 25% | n/a Browse Formulary | |||||
Geisinger Gold Classic 3 $0 Deductible Rx (HMO) - H3954-100-0 Benefit Details |
Lebanon | $33.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PPO Basic Rx (PPO) - H3916-018-0 Benefit Details |
Lebanon | $34.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 5,847 members Browse Formulary | |||||
SecureHorizons MedicareDirect Rx Plan 150 (PFFS) - H5435-027-0 Benefit Details |
Lebanon | $35.00 | $0 | No Gap Coverage | Tier 1 Preferred Generic Brand: $6.00 Tier 2 Generic Preferred Brand: $42.00 Tier 3 Non-Preferred Generic Non-Preferred Brand: $80.00 Tier 4 Specialty: 33% | 4,555 members Browse Formulary | |||||
Geisinger Gold Preferred Standard Rx (PPO) - H3924-022-0 Benefit Details |
Lebanon | $37.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 126 members Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SeniorBlue - Option 3 (PPO) - H3923-021-0 Benefit Details |
Lebanon | $38.60 | $0 | No Gap Coverage | Generic Drugs: $9.00 Formulary Brand Drugs: $45.00 Specialty Drugs: 33% | 352 members Browse Formulary | |||||
Sterling Basic Plus (PFFS) - H5006-018-1 Benefit Details |
Lebanon | $39.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 10,911 members | ||||||
FreedomBlue PPO Value (PPO) - H3916-012-0 Benefit Details |
Lebanon | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Geisinger Gold Preferred $0 Deductible Rx (PPO) - H3924-023-0 Benefit Details |
Lebanon | $41.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | n/a Browse Formulary | |||||
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Humana Gold Choice H2944-074 (PFFS) - H2944-074-0 Benefit Details |
Lebanon | $41.00 | $0 | Few Generics, Few Brand | Preferred Generic: $8.00 Non-Preferred Generic/Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 13,285 members Browse Formulary | |||||
Today's Options Premier powered by CCRx (PFFS) - H3333-105-0 Benefit Details |
Lebanon | $44.00 | $0 | All Generics | Generic: $5.00 Preferred Brand: $35.00 Non-Preferred Brand: $65.00 Specialty: 33% | 173 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
CIGNA Medicare Access Plan Three (PFFS) - H2762-024-0 Benefit Details |
Lebanon | $45.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 3,787 members | ||||||
Geisinger Gold Classic 2 Standard Rx (HMO) - H3954-050-0 Benefit Details |
Lebanon | $54.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | 70 members Browse Formulary | |||||
SecurityChoice Classic (PFFS) - H0540-088-0 Benefit Details |
Lebanon | $55.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SecurityChoice Plus (PFFS) - H0540-089-0 Benefit Details |
Lebanon | $56.00 | $0 | Many Generics | Tier 1 Preferred Generic Drugs: $8.00 Tier 2 Preferred Brand Certain Generic Drugs: $44.00 Tier 3 Non-Preferred Brand Certain Generic Drugs: $85.00 Tier 4 Non-Specialty Injectable Drugs: 33% Tier 5 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Geisinger Gold Classic 2 $0 Deductible Rx (HMO) - H3954-051-0 Benefit Details |
Lebanon | $58.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 231 members Browse Formulary | |||||
Any, Any, Any Platinum (PFFS) - H5820-008-0 Benefit Details |
Lebanon | $59.00 | $0 | No Gap Coverage | Value Generic: $2.00 Generic: $7.00 Preferred Brand: $30.00 Non Preferred Brand: $60.00 Speciality: 33% | 75 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option I (PFFS) - H5006-014-1 Benefit Details |
Lebanon | $59.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 43,891 members | ||||||
FreedomBlue PFFS Choice (PFFS) - H9793-002-0 Benefit Details |
Lebanon | $60.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | 174 members | ||||||
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Advantra Gold (PPO) - H5522-002-0 Benefit Details |
Lebanon | $66.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $2.00 Tier 2 - Preferred Brand: $40.00 Tier 3 - Non-Preferred Generic/Non-Preferred Brand: $75.00 Tier 4 - Specialty Drugs: 33% | 4,762 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Statewide | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
HumanaChoice R5826-081 (Regional PPO) - R5826-081-0 Benefit Details |
Lebanon | $67.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% | 590 members Browse Formulary | |||||
Aetna Medicare Premier Plan (HMO) - H3931-077-0 Benefit Details |
Lebanon | $69.00 | $0 | Many Generics | Tier 1 - Preferred Generic: $5.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 33% | 760 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
FreedomBlue PFFS Choice Plus (PFFS) - H9793-001-0 Benefit Details |
Lebanon | $71.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $90.00 Specialty: 33% | 464 members Browse Formulary | |||||
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CIGNA Medicare Access Plus RX Plan Four (PFFS) - H2762-050-0 Benefit Details |
Lebanon | $85.00 | $0 | No Gap Coverage | Tier 1: $7.00 Tier 2: $35.00 Tier 3: $75.00 Tier 4: 33% | 9,959 members Browse Formulary | |||||
Geisinger Gold Classic 1 (HMO) - H3954-007-0 Benefit Details |
Lebanon | $88.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Lebanon | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
HumanaChoice R5826-002 (Regional PPO) - R5826-002-0 Benefit Details |
Statewide | $95.00 | $0 | Few Generics, Few Brand | Preferred Generic: $10.00 Non-Preferred Generic/Preferred Brand: $42.00 Non-Preferred Brand: $85.00 Specialty: 33% | 2,986 members Browse Formulary | |||||
Geisinger Gold Secure 2 (HMO) - H3954-106-0 Benefit Details |
Lebanon | $96.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | < 10 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
SeniorBlue - Option 2 (PPO) - H3923-013-0 Benefit Details |
Lebanon | $96.70 | $0 | Many Generics | Generic Drugs: $8.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $90.00 Specialty Drugs: 33% | n/a Browse Formulary | |||||
Sterling Option II (PFFS) - H5006-017-1 Benefit Details |
Lebanon | $99.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $34.00 Specialty: 25% | 8,639 members Browse Formulary | |||||
FreedomBlue PPO Standard (PPO) - H3916-015-0 Benefit Details |
Lebanon | $102.00 | $0 | No Gap Coverage | Generic: $7.00 Preferred Brand: $42.00 Non-Preferred Brand: $80.00 Specialty: 33% | 7,736 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Standard Plan (PPO) - H5521-011-0 Benefit Details |
Lebanon | $115.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $9.00 Tier 2 - Non-Preferred Generic: $32.00 Tier 3 - Preferred Brand: $38.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 146 members Browse Formulary | |||||
Geisinger Gold Secure 3 (HMO) - H3954-135-0 Benefit Details |
Lebanon | $115.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 16 members Browse Formulary | |||||
Geisinger Gold Classic 1 Standard Rx (HMO) - H3954-032-0 Benefit Details |
Lebanon | $117.00 | $310 | No Gap Coverage | Tier 1: 25% Tier 2: 25% | n/a Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Sterling Option IV (PFFS) - H5006-016-1 Benefit Details |
Lebanon | $119.00 | $225 | No Gap Coverage | Generic: $10.00 Brand: $36.00 Specialty: 25% | 3,337 members Browse Formulary | |||||
Geisinger Gold Classic 1 $0 Deductible Rx (HMO) - H3954-033-0 Benefit Details |
Lebanon | $121.00 | $0 | No Gap Coverage | Tier 1: $6.00 Tier 2: $39.00 Tier 3: $69.00 Tier 4: 33% | 2,712 members Browse Formulary | |||||
FreedomBlue PPO Deluxe (PPO) - H3916-005-0 Benefit Details |
Lebanon | $138.00 | $0 | Many Generics | Generic: $6.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty: 33% | 17,715 members Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible | Gap Coverage | Preferred Pharmacy Copay/ Coinsurance |
Plan ID Members | |||||
Service | Exper. | Cost Info | |||||||||
Aetna Medicare Premier Plan (PPO) - H5521-012-0 Benefit Details |
Lebanon | $140.00 | $0 | No Gap Coverage | Tier 1 - Preferred Generic: $6.00 Tier 2 - Non-Preferred Generic: $30.00 Tier 3 - Preferred Brand: $40.00 Tier 4 - Non-Preferred Brand: $80.00 Tier 5 - Specialty: 25% | 693 members Browse Formulary | |||||
SeniorBlue - Option 1 (PPO) - H3923-017-0 Benefit Details |
Lebanon | $143.60 | $0 | Many Generics | Generic Drugs: $6.00 Preferred Brand Drugs: $35.00 Non-Preferred Brand Drugs: $90.00 Specialty Drugs: 33% | 5,232 members Browse Formulary | |||||
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