ACTIQ 200MCG LOZENGE (30 BOT) (NDC: 63459050230)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer 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 |
GHI Medicare PPO Any Dual (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,078.50 |
Browse Plan Formulary |
GHI Medicare PPO Value (PPO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,078.50 |
Browse Plan Formulary |
Healthfirst Medicare Plus Plan (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $910.73 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
HIP VIP Dual Eligible (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,084.50 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Medicaid Advantage (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
40% | 40% | None | $1,126.28 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
MediBlue Value (HMO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
MediBlue Value (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
MediBlue Select (HMO)
|
$2.60 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $924.61 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$5.50 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$12.90 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $924.61 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO II (PPO)
|
$15.20 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.00 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO Plan ONE (PPO)
|
$19.30 |
$150 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,075.13 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
HIP VIP Plus (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $1,142.50 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere (PFFS
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$27.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:4 /1Days | $1,063.94 |
Browse Plan Formulary |
Evercare Plan IH (HMO)
|
$29.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:4 /1Days | $1,063.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
|
$31.40 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,078.50 |
Browse Plan Formulary |
Healthfirst Increased Benefits Plan (HMO)
|
$33.00 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | P Q:120 /30Days | $1,112.27 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Independent Health Medicare Anywhere Basic
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,120.81 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Medicare Blue PPO - TWO (PPO)
|
$37.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P Q:120 /30Days | $1,075.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
GHI Medicare PPO III (PPO)
|
$45.80 |
$0 | to be determined | 3 |
Tier 3 |
50% | 50% | None | $1,126.28 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Independent Health Medicare Passport (PPO)
|
$47.20 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | n/a | None | $1,066.13 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
Independent Health Encompass 65 Extra (HMO
|
$52.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | None | $1,065.84 |
Browse Plan Formulary |
MediBlue Plus (PPO)
|
$70.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P Q:120 /30Days | $924.61 |
Browse Plan Formulary |