TRANSDERM-SCOP 1.5MG 24 PKG (24 PKG) (NDC: 10019055302)
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 |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $251.06 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $251.06 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $251.06 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $251.06 |
Browse Plan Formulary |
Amerivantage Balance + Rx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$20.00 | $40.00 | None | $251.06 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Achieve (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | None | $252.94 |
Browse Plan Formulary |
Bravo Classic Plus (HMO-POS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $140.00 | None | $252.94 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.52 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $252.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.44 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.31 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.13 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.13 |
Browse Plan Formulary |
Evercare Plan MP (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $245.00 | None | $249.32 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Medicare Masterpiece (HMO-POS)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Molina Medicare Options (HMO)
|
$0.00 |
$0 | to be determined | 2 |
Tier 2 |
$35.00 | $75.00 | None | $251.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Standard (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:4 /12Days | $263.81 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Texas Community Care - Plus (HMO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$39.00 | $78.00 | None | $250.72 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $253.49 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$1.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.85 |
Browse Plan Formulary |
Care Improvement Plus Medicare Advantage (
|
$1.80 |
$0 | to be determined | 2 |
Tier 2 |
$39.00 | $97.50 | None | $252.69 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$4.00 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.85 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.22 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.53 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
HumanaChoice H4520-016 (PPO)
|
$6.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$6.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.71 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.71 |
Browse Plan Formulary |
Today's Options Advantage 1 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $253.71 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.71 |
Browse Plan Formulary |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.71 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 2 powered by CCR
|
$8.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $253.42 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$9.90 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.30 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
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 |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$10.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 150
|
$10.90 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.42 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $230.00 | None | $249.50 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$11.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (R
|
$12.00 |
$0 | to be determined | 2 |
Tier 2 |
$45.00 | $112.50 | None | $252.69 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.10 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$12.30 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.76 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$12.30 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
HumanaChoice R5826-012 (Regional PPO)
|
$13.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.91 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.60 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Value powered by CCRx (PFF
|
$13.70 |
$310 | to be determined | 3 |
Tier 3 |
25% | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Gold (PFFS)
|
$14.70 |
$0 | to be determined | 4 |
Tier 4 |
$70.00 | $140.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$14.80 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.53 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$16.40 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.65 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$16.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
Humana Gold Choice H2944-026 (PFFS)
|
$17.40 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $248.81 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:12 /36Days | $252.45 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:12 /36Days | $252.45 |
Browse Plan Formulary |
Plan Name |
Monthly 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 Valley (HMO)
|
$18.40 |
$0 | to be determined | 3 |
Tier 3 |
$40.00 | $120.00 | Q:12 /36Days | $252.45 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Advantage 3 powered by CCR
|
$18.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$18.70 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.20 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 1 powered by CCR
|
$19.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $253.42 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
TexanPlus Premier powered by CCRx (HMO)
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.00 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.64 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$22.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.09 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $258.49 |
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 | $256.72 |
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 | $256.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $256.72 |
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 | $256.72 |
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 | $256.72 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $256.19 |
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 | $256.72 |
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 | $256.72 |
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 | $256.72 |
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 | $256.72 |
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 | $256.72 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 3 |
Tier 3 |
$75.00 | $187.50 | None | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $256.19 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
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 | $258.25 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Any, Any, Any Platinum (PFFS)
|
$23.30 |
$0 | to be determined | 4 |
Tier 4 |
$60.00 | $120.00 | None | $252.76 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Freedom (PPO)
|
$24.30 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier DFW
|
$25.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $251.29 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Bravo Liberty II Rx (PFFS)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $160.00 | None | $252.83 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /12Days | $252.24 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus SNP-DE H4510-017 (HMO)
|
$25.70 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /12Days | $252.24 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H4510-019 (HMO)
|
$25.80 |
$0 | to be determined | 3 |
Tier 3 |
$60.00 | $150.00 | Q:4 /12Days | $247.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$26.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.94 |
Browse Plan Formulary |
Texas Community Care - Dual Plus (HMO)
|
$26.20 |
$310 | to be determined | 2 |
Tier 2 |
n/a | n/a | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Texas Community Care - Enhanced (HMO)
|
$27.20 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.50 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $252.84 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $252.84 |
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 |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $252.84 |
Browse Plan Formulary |
Bravo Traditions (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $252.84 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$27.50 |
$0 | to be determined | 2 |
Tier 2 |
$43.00 | $107.50 | None | $252.69 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort (HMO)
|
$27.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $249.54 |
Browse Plan Formulary |
Molina Medicare Options Plus (HMO)
|
$27.50 |
$310 | to be determined | 2 |
Tier 2 |
$45.00 | $135.00 | None | $251.00 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.45 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.45 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.45 |
Browse Plan Formulary |
Arkansas Community Care - Enhanced (HMO)
|
$28.50 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | None | $250.45 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
Physicians Health Choice Extra (HMO)
|
$30.00 |
$0 | to be determined | 3 |
Tier 3 |
$70.00 | $195.00 | None | $255.04 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-024 (PFFS)
|
$32.60 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $249.69 |
Browse Plan Formulary |
HumanaChoice R5826-075 (Regional PPO)
|
$33.10 |
$310 | to be determined | 3 |
Tier 3 |
25% | 25% | Q:4 /12Days | $248.91 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Humana Gold Choice H2944-027 (PFFS)
|
$33.50 |
$0 | to be determined | 3 |
Tier 3 |
$80.00 | $200.00 | Q:4 /12Days | $247.75 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.53 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$38.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.53 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Advantage 3 powered by CCR
|
$40.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $253.42 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
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 |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.84 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$44.60 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $256.25 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Comfort Plus (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Fidelis Secure Independence (HMO)
|
$47.40 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | $130.00 | None | $249.54 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
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 |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$47.50 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.48 |
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 |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Sadler (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $249.93 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Select (HMO)
|
$47.90 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.73 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
HealthSpring HealthyAdvantage Premier (PPO
|
$50.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $253.21 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $255.03 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$50.80 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.82 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Today's Options Premier powered by CCRx (P
|
$53.10 |
$0 | to be determined | 3 |
Tier 3 |
$65.00 | n/a | Q:11 /31Days | $254.95 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |
HealthSpring OptimaCare (HMO)
|
$78.00 |
$0 | to be determined | 3 |
Tier 3 |
$30.00 | $90.00 | Q:12 /36Days | $250.87 |
Browse Plan Formulary |