INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG (500 ML BAG) (NDC: 00338052003)
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 Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$72.00 | $206.00 | P | $1,067.70 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
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 |
Network PlatinumSelect (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $889.21 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
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 |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
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 |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $893.44 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
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 |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,050.64 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
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 | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,067.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-067 (PFFS)
|
$16.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-065 (PFFS)
|
$19.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-069 (PFFS)
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
HumanaChoice H5216-008 (PPO)
|
$21.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
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-POS (HMO-POS)
|
$22.60 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
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-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
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-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$22.80 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,067.70 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-070 (PFFS)
|
$23.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Network PlatinumPlus Pharmacy (PPO)
|
$27.90 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $889.21 |
Browse Plan Formulary |
HumanaChoice H5216-003 (PPO)
|
$29.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
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 |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Humana Gold Choice H2944-066 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,020.90 |
Browse Plan Formulary |
Evercare Plan IH-POS (HMO-POS)
|
$38.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | P | $1,067.70 |
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 |
Network Cares (PPO)
|
$38.20 |
$0 | to be determined | 3 |
Tier 3 |
$0.00 | $0.00 | None | $889.21 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
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 |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $887.65 |
Browse Plan Formulary |
Network PlatinumPremier Pharmacy (PPO)
|
$42.20 |
$0 | to be determined | 3 |
Tier 3 |
$26.00 | $68.00 | None | $889.21 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,049.05 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $887.65 |
Browse Plan Formulary |