AMPICILLIN POWDER FOR INJECTION 1 GM/ML (10 PKG OF 10 VIALS VIAL) (NDC: 00781340495)
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 |
AARP MedicareComplete Plan 1 (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $116.00 | None | $74.07 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$30.00 | $60.00 | None | $62.27 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $15.00 | None | $80.32 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $75.03 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $75.03 |
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 |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $75.03 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $74.07 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $74.07 |
Browse Plan Formulary |
Health Net Ruby 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
Humana Gold Plus H0307-011 (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $85.48 |
Browse Plan Formulary |
MediSunONE Classic (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $79.92 |
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 |
SCAN Health Plan Arizona (HMO)
|
$0.00 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | $10.00 | None | $79.94 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
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 | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
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 | 4 |
Tier 4 |
33% | 33% | None | $79.19 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $74.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $72.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $72.91 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus (HMO)
|
$8.80 |
$0 | to be determined | 2 |
Tier 2 |
$20.00 | $40.00 | None | $72.50 |
Browse Plan Formulary |
CIGNA Medicare Select Plus Rx-Dual (HMO)
|
$9.70 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $80.32 |
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 |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $74.07 |
Browse Plan Formulary |
AARP MedicareComplete Plan 3 (HMO)
|
$9.90 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $125.00 | None | $74.07 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $67.90 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $74.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $74.95 |
Browse Plan Formulary |
Desert Canyon Community Care - Plus Point
|
$11.60 |
$0 | to be determined | 2 |
Tier 2 |
$12.00 | $24.00 | None | $72.50 |
Browse Plan Formulary |
Evercare Plan DH (HMO)
|
$11.80 |
$310 | to be determined | 2 |
Tier 2 |
15% | 15% | None | $74.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $64.57 |
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 | 2 |
Tier 2 |
$10.00 | $20.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $64.57 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 1 |
Tier 1 |
25% | n/a | None | $69.73 |
Browse Plan Formulary |
MediSunONE Plus (HMO)
|
$14.00 |
$100* | to be determined | 2* |
Tier 2 |
$12.00 | $33.00 | None | $79.92 |
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 |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 2 |
Tier 2 |
$10.00 | $20.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
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 | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
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 | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Health Net Ruby 1 (HMO)
|
$15.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
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 |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
Health Net Ruby 3 (HMO)
|
$15.60 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | None | $74.09 |
Browse Plan Formulary |
SCAN Health Plan Arizona (HMO)
|
$16.00 |
$310 | to be determined | 1 |
Tier 1 |
n/a | n/a | None | $79.94 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $63.60 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $63.60 |
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 | 2 |
Tier 2 |
$7.00 | $14.00 | None | $63.60 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $72.91 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $72.91 |
Browse Plan Formulary |
Humana Gold Plus H0307-008 (HMO)
|
$19.50 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $85.48 |
Browse Plan Formulary |
Humana Gold Plus H0307-010 (HMO-POS)
|
$19.50 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $85.48 |
Browse Plan Formulary |
Maricopa Care Advantage (HMO)
|
$19.60 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $79.06 |
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 |
Mercy Care Advantage (HMO)
|
$19.60 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $79.93 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 2 |
Tier 2 |
$7.00 | $14.00 | None | $64.57 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $78.22 |
Browse Plan Formulary |
Health Choice Generations (HMO)
|
$24.70 |
$0 | to be determined | 1 |
Tier 1 |
$0.00 | $0.00 | None | $78.39 |
Browse Plan Formulary |
Health Net Amber (HMO)
|
$24.70 |
$310 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $74.09 |
Browse Plan Formulary |
Abrazo Advantage Plus (HMO)
|
$24.80 |
$310 | to be determined | 1 |
Tier 1 |
15% | n/a | None | $79.06 |
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 |
APIPA Personal Care Plus (HMO)
|
$24.80 |
$310 | to be determined | 1 |
Tier 1 |
15% | 15% | None | $73.49 |
Browse Plan Formulary |
Evercare Plan IP (PPO)
|
$24.80 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $74.07 |
Browse Plan Formulary |
Abrazo Advantage (HMO)
|
$25.00 |
$0 | to be determined | 1 |
Tier 1 |
$10.00 | $30.00 | None | $79.06 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $73.61 |
Browse Plan Formulary |
Humana Gold Choice H2944-028 (PFFS)
|
$25.20 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $73.61 |
Browse Plan Formulary |
Humana Gold Choice H2944-029 (PFFS)
|
$27.50 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
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 H2944-029 (PFFS)
|
$27.50 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-030 (PFFS)
|
$33.40 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $73.61 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-031 (PFFS)
|
$34.10 |
$0 | to be determined | 2 |
Tier 2 |
$38.00 | $95.00 | None | $85.48 |
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 R5826-076 (Regional PPO)
|
$34.20 |
$310 | to be determined | 2 |
Tier 2 |
25% | 25% | None | $85.48 |
Browse Plan Formulary |
HumanaChoice H0317-002 (PPO)
|
$36.70 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $85.48 |
Browse Plan Formulary |
HumanaChoice R5826-014 (Regional PPO)
|
$38.90 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $85.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $67.90 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $67.90 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $67.90 |
Browse Plan Formulary |
MediSunONE HeartSmart (HMO)
|
$45.00 |
$50* | to be determined | 2* |
Tier 2 |
$12.00 | $33.00 | None | $79.92 |
Browse Plan Formulary |
MediSunONE Premier (HMO)
|
$45.00 |
$50* | to be determined | 2* |
Tier 2 |
$12.00 | $33.00 | None | $79.92 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $74.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $74.95 |
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 H0317-001 (PPO)
|
$50.50 |
$0 | to be determined | 2 |
Tier 2 |
$42.00 | $105.00 | None | $85.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 1 |
Tier 1 |
$5.00 | n/a | None | $69.73 |
Browse Plan Formulary |