RENAMIN 6.5% IV SOLUTION (500 ML BAG) (NDC: 00338047103)
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 |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | P | $1,140.93 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | P | $1,140.93 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$39.00 | $78.00 | P | $1,140.93 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$39.00 | $78.00 | P | $1,140.93 |
Browse Plan Formulary |
Arcadian Health Plan - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$39.00 | $78.00 | P | $1,140.93 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | P | $1,555.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,555.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,555.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | P | $1,555.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$8.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
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 |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$19.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$19.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$19.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$19.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
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 |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$22.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,040.44 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-023 (PFFS)
|
$24.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-022 (PFFS)
|
$30.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Humana Gold Choice H2944-021 (PFFS)
|
$36.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | P | $1,195.50 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | $1,034.05 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
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 | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | $1,034.05 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Medicare Blue PPO (PPO)
|
$45.50 |
$0 | to be determined | 4 |
Tier 4 |
30% | 30% | None | $1,034.76 |
Browse Plan Formulary |
Plan Name |
Monthly 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
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
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 |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | P | $1,636.20 |
Browse Plan Formulary |