2014 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) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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BlueSaver MSA (MSA) - H9788-002-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Fidelis Medicare $0 Premium (HMO) - H3328-019-0 Benefit Details |
Schenectady | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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Fidelis Medicare Advantage without Rx (HMO-POS) - H3328-001-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Humana Gold Plus H3533-006 (HMO) - H3533-006-0 Benefit Details |
Schenectady | $0.00 | $0 | Few Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $18.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,500 Browse Formulary | |||||
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Today's Options Advantage 800 (PPO) - H2775-094-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
Today's Options Premier 400 (PFFS) - H2816-007-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,400 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
UnitedHealthcare MedicareComplete Choice (Regional PPO) - R5342-001-0 Benefit Details |
Schenectady | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $4.00 Non-Preferred Generic: $8.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $5,200 Browse Formulary | |||||
UnitedHealthcare MedicareComplete Choice Essential (Regional PPO) - R5342-002-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $5,200 | ||||||
VNSNY CHOICE Medicare Enhanced (HMO) - H5549-004-0 Benefit Details |
Schenectady | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $0.00 Preferred Brand: $30.00 Non-Preferred Brand: $90.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Advance (HMO) - H3361-059-0 Benefit Details |
Schenectady | $0.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $6,700 | ||||||
WellCare Value (HMO-POS) - H3361-099-0 Benefit Details |
Schenectady | $0.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $10.00 Preferred Brand: $44.00 Non-Preferred Brand: $79.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Humana Gold Plus HMO-SNP-DE H3533-008 (HMO SNP) - H3533-008-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $13.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Preferred Gold without Part D (HMO-POS) - H9859-001-0 Benefit Details |
Schenectady | $18.40 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $4,500 | ||||||
WellCare Access (HMO SNP) - H3361-065-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $15.00 Non-Preferred Brand: $40.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
CDPHP Choice (HMO) - H3388-001-0 Benefit Details |
Schenectady | $24.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $2,500 | ||||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
BasiCare with Part D (PPO) - H9615-008-0 Benefit Details |
Schenectady | $27.00 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $4,000 Browse Formulary | |||||
VNSNY CHOICE Medicare Maximum (HMO SNP) - H5549-006-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
CDPHP Value Rx (HMO) - H3388-004-0 Benefit Details |
Schenectady | $32.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $9.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,300 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
WellCare Liberty (HMO SNP) - H3361-098-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $2.00 Preferred Brand: $15.00 Non-Preferred Brand: $40.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
UnitedHealthcare Nursing Home Plan (HMO SNP) - H3379-022-0 Benefit Details |
Schenectady | $35.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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Today's Options Advantage Plus 850B (PPO) - H2775-088-0 Benefit Details |
Schenectady | $36.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Today's Options Premier Plus 850B (PFFS) - H2816-019-0 Benefit Details |
Schenectady | $37.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 29% | n/a Browse Formulary | |||||
Fidelis Dual Advantage (HMO SNP) - H3328-002-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $16.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Fidelis Dual Advantage Flex (HMO SNP) - H3328-017-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | Some Generics | Preferred Generic: $0.00 Non-Preferred Generic: $23.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
|||||
Service | Exper. | Cost Info | |||||||||
Fidelis Medicaid Advantage Plus (HMO SNP) - H3328-016-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $29.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | n/a Browse Formulary | |||||
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Fidelis Medicare Advantage Flex (HMO-POS) - H3328-003-0 Benefit Details |
Schenectady | $37.20 | $240 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $15.00 Preferred Brand: $35.00 Non-Preferred Brand: $95.00 Specialty Tier: 25% | $6,700 Browse Formulary | |||||
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VNSNY CHOICE Medicare Classic (HMO) - H5549-008-0 Benefit Details |
Schenectady | $37.20 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
VNSNY CHOICE Medicare Preferred (HMO SNP) - H5549-002-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: 15% Tier 2: 15% Tier 3: 15% Tier 4: 15% Tier 5: 15% | n/a Browse Formulary | |||||
VNSNY CHOICE Total (HMO SNP) - H5549-003-0 Benefit Details |
Schenectady | $0.00 for people who qualify for both Medicare and Medicaid. | $0 for people who qualify for both Medicare and Medicaid. | No additional gap coverage, only the Donut Hole Discount | Tier 1: 0% Tier 2: 0% Tier 3: 0% Tier 4: 0% Tier 5: 0% | n/a Browse Formulary | |||||
BlueShield Senior Blue 650 Part D (HMO-POS) - H3384-059-0 Benefit Details |
Schenectady | $39.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Today's Options Premier 100 (PFFS) - H2816-001-0 Benefit Details |
Schenectady | $40.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | n/a | ||||||
Fidelis Long Term Care Advantage (HMO SNP) - H3328-018-0 Benefit Details |
Schenectady | $44.50 | $310 | No additional gap coverage, only the Donut Hole Discount | Tier 1: 25% Tier 2: 25% Tier 3: 25% Tier 4: 25% Tier 5: 25% | n/a Browse Formulary | |||||
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HumanaChoice H5970-008 (PPO) - H5970-008-0 Benefit Details |
Schenectady | $48.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Empire MediBlue Freedom I (PPO) - H3342-012-0 Benefit Details |
Schenectady | $50.00 | $125 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $11.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Specialty Tier: 33% | $4,500 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
GoldValue with Part D (HMO-POS) - H9859-013-0 Benefit Details |
Schenectady | $59.50 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $6,000 Browse Formulary | |||||
GoldAnywhere with Part D - Option 2 (PPO) - H9615-007-0 Benefit Details |
Schenectady | $64.00 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $4,000 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Empire MediBlue Plus (HMO) - H3370-014-0 Benefit Details |
Schenectady | $67.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Tier 6: 33% | $4,000 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
Empire MediBlue Freedom II (PPO) - H3342-014-0 Benefit Details |
Schenectady | $72.00 | $90 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Injectable Drugs: $95.00 Tier 6: 33% | $3,700 Browse Formulary | |||||
Higher cost-sharing at standard network pharmacies. Details: | |||||||||||
CDPHP Choice Rx (HMO) - H3388-002-0 Benefit Details |
Schenectady | $81.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $90.00 Specialty Tier: 30% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Today's Options Advantage Plus 350A (PPO) - H2775-082-0 Benefit Details |
Schenectady | $90.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | $3,250 Browse Formulary | |||||
Today's Options Premier Plus 350A (PFFS) - H2816-013-0 Benefit Details |
Schenectady | $92.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $2.00 Non-Preferred Generic: $7.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 33% | n/a Browse Formulary | |||||
BlueShield Senior Blue HMO 652 PartD (HMO) - H3384-013-0 Benefit Details |
Schenectady | $99.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $3.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
CDPHP Classic (PPO) - H5042-004-0 Benefit Details |
Schenectady | $110.00 | No Rx Coverage | This Plan does NOT include Prescription Drug coverage. | $3,400 | ||||||
Preferred Gold with Part D (HMO-POS) - H9859-002-0 Benefit Details |
Schenectady | $117.00 | $0 | Few Generics | Preferred Generic: $10.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $4,500 Browse Formulary | |||||
CDPHP Core Rx (PPO) - H5042-005-0 Benefit Details |
Schenectady | $126.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $0.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
HumanaChoice H5970-010 (PPO) - H5970-010-0 Benefit Details |
Schenectady | $133.00 | $0 | Few Generics, Few Brands | Preferred Generic: $6.00 Non-Preferred Generic: $15.00 Preferred Brand: $45.00 Non-Preferred Brand: $95.00 Specialty Tier: 33% | $6,700 Browse Formulary | |||||
BlueShield Forever Blue Medicare PPO 750 (PPO) - H5526-014-0 Benefit Details |
Schenectady | $144.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Preferred Generic: $5.00 Non-Preferred Generic: $12.00 Preferred Brand: $45.00 Non-Preferred Brand: 50% Specialty Tier: 30% | $3,400 Browse Formulary | |||||
CDPHP Classic Rx (PPO) - H5042-001-0 Benefit Details |
Schenectady | $182.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $10.00 Preferred Brand: $40.00 Non-Preferred Brand: $95.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
GoldAnywhere with Part D - Option 1 (PPO) - H9615-002-0 Benefit Details |
Schenectady | $238.00 | $0 | Few Generics | Preferred Generic: $8.00 Preferred Brand: $35.00 Non-Preferred Brand: $90.00 Specialty Tier: 33% Select Care Drugs: $0.00 | $2,000 Browse Formulary | |||||
CDPHP Prime Rx (PPO) - H5042-007-0 Benefit Details |
Schenectady | $256.00 | $0 | Some Generics, Few Brands | Preferred Generic: $0.00 Non-Preferred Generic: $8.00 Preferred Brand: $40.00 Non-Preferred Brand: $80.00 Specialty Tier: 30% | $3,400 Browse Formulary | |||||
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