ACTONEL 35MG TABLET (4 CRTN) (NDC: 00149047201)
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 |
Aetna Medicare Dual Advantage Plan (HMO)
|
$0.00 |
$310 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | Q:4 /28Days | $107.73 |
Browse Plan Formulary |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | S Q:4 /30Days | $108.24 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | S Q:4 /30Days | $108.24 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
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 |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
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 |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.11 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $108.17 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.83 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.83 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.83 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.83 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.82 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.82 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | Q:4 /28Days | $106.81 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.13 |
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 |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.13 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $75.00 | None | $107.54 |
Browse Plan Formulary |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$15.00 | $30.00 | S Q:4 /28Days | $109.92 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
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)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /28Days | $114.56 |
Browse Plan Formulary |
Texas Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$69.00 | $138.00 | None | $107.64 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
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 |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.24 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$39.00 | $97.50 | None | $108.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
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 |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.24 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
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 |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
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 |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
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 |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.17 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
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 |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.88 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | Q:4 /28Days | $106.99 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $108.17 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
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 |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.16 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
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 |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.20 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
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 |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.22 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:4 /28Days | $108.43 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:4 /28Days | $108.43 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:4 /28Days | $108.43 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
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 |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | S | $108.16 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
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 |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $70.00 | Q:4 /30Days | $108.22 |
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 |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.31 |
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 |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
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 |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 2 |
Tier 2 |
$40.00 | $80.00 | Q:4 /30Days | $108.27 |
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 |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /28Days | $100.60 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /28Days | $100.60 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /28Days | $99.91 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
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 |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.58 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /30Days | $108.22 |
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 |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /30Days | $108.22 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 | to be determined | 2 |
Tier 2 |
$43.00 | $107.50 | None | $108.17 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
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 |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | Q:4 /28Days | $106.86 |
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 |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | None | $107.54 |
Browse Plan Formulary |
Physicians Health Choice Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | S Q:4 /28Days | $110.09 |
Browse Plan Formulary |
Physicians Health Choice Select (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | S Q:4 /28Days | $110.09 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.53 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.53 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.53 |
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 |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 4 |
Tier 4 |
25% | 25% | None | $107.53 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $60.00 | S Q:4 /28Days | $109.92 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $60.00 | S Q:4 /28Days | $109.92 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $60.00 | S Q:4 /28Days | $109.92 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $60.00 | S Q:4 /28Days | $109.92 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 2 |
Tier 2 |
$25.00 | $60.00 | S Q:4 /28Days | $109.92 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
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 |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:4 /28Days | $100.23 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
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 |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
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 |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /28Days | $100.34 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:4 /28Days | $107.21 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$34.20 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:4 /28Days | $107.21 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:4 /28Days | $107.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$43.10 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $80.00 | Q:4 /28Days | $107.72 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$38.00 | $76.00 | Q:4 /28Days | $108.14 |
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 |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$38.00 | $76.00 | Q:4 /28Days | $108.14 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$38.00 | $76.00 | Q:4 /28Days | $108.14 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$46.00 |
$0 | to be determined | 3 |
Tier 3 |
$38.00 | $76.00 | Q:4 /28Days | $108.14 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
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 |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
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 |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
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 |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | Q:4 /28Days | $106.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
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 |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.71 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
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 |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.86 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
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 |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
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 |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
FirstCare Advantage Platinum (HMO)
|
$50.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $75.00 | S Q:5 /35Days | $111.03 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
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 |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $107.98 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
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 |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
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 |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
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 |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
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 |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:4 /28Days | $108.06 |
Browse Plan Formulary |