SUBUTEX 2MG TABLET (NDC: 12496127802)
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 |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MH-POS (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$69.00 | $138.00 | None | $144.41 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$44.00 | $88.00 | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$44.00 | $88.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$44.00 | $88.00 | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$44.00 | $88.00 | None | n/a |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.55 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.55 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 2 |
Tier 2 |
$44.00 | $110.00 | P Q:16 /90Days | $154.60 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | n/a |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Care Improvement Plus Medicare Advantage (
|
$12.10 |
$0 | to be determined | 2 |
Tier 2 |
$37.00 | $92.50 | None | n/a |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $145.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 3 |
Tier 3 |
$35.00 | $70.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.48 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $146.07 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-113 (PFFS)
|
$18.10 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$18.80 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | n/a |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-117 (PFFS)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-117 (PFFS)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$22.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | n/a |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $146.55 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.98 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $144.10 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $147.39 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $60.00 | None | $145.27 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-116 (PFFS)
|
$23.80 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
HumanaChoice H5214-008 (PPO)
|
$24.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $144.13 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
Humana Gold Choice H2944-114 (PFFS)
|
$25.20 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.88 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |
HealthSpring HealthyLiving Preferred NGA (
|
$26.00 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | P | $147.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | P | $147.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | P | $147.10 |
Browse Plan Formulary |
Aetna Medicare Premier Plan (PPO)
|
$30.60 |
$0 | to be determined | 4 |
Tier 4 |
$80.00 | $160.00 | P | $147.10 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-115 (PFFS)
|
$31.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $146.84 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-118 (PFFS)
|
$32.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
Humana Gold Choice H2944-118 (PFFS)
|
$32.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | None | $145.68 |
Browse Plan Formulary |
HumanaChoice R5826-004 (Regional PPO)
|
$33.30 |
$0 | to be determined | 3 |
Tier 3 |
$84.00 | $210.00 | None | $145.96 |
Browse Plan Formulary |
HumanaChoice R5826-077 (Regional PPO)
|
$35.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $145.96 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Sterling Option II (PFFS)
|
$39.90 |
$225 | to be determined | 2 |
Tier 2 |
$34.00 | $68.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly 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 | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Sterling Option IV (PFFS)
|
$44.70 |
$225 | to be determined | 2 |
Tier 2 |
$36.00 | $72.00 | None | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select NGA (
|
$45.50 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | P Q:24 /30Days | $146.30 |
Browse Plan Formulary |