TREANDA FOR INJECTION 100MG/VIAL (1 VIALSU) (NDC: 63459039120)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP MedicareComplete (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
AARP MedicareComplete Plus Plan 1 (HMO-POS
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 1 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 4 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx (Regional PP
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,799.91 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Gold Advantage Option 1 (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE (HMO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Mercy MedicareADVANTAGE Plan 2 (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
25% | n/a | None | $1,715.56 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 55 (
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Anthem Medicare Preferred Select (PPO)
|
$2.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$6.20 |
$0 | to be determined | 5 |
Tier 5 |
33% | n/a | P | $1,625.48 |
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 |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
SecureHorizons MedicareDirect Rx Plan 51 (
|
$11.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Plus Point (HMO-POS)
|
$13.00 |
$0 | to be determined | 5 |
Tier 5 |
33% | 33% | None | $1,855.62 |
Browse Plan Formulary |
Care Improvement Plus Gold Rx Advantage (
|
$14.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,799.91 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-013 (PFFS)
|
$17.80 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Choice H2944-014 (PFFS)
|
$18.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Plan Name |
Monthly 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)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$18.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Plan Name |
Monthly 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 H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Humana Gold Plus H2649-016 (HMO)
|
$19.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
AARP MedicareComplete Choice (PPO)
|
$19.40 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,943.79 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$20.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Plan Name |
Monthly 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 | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | P | $1,899.01 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Advantra Freedom (PPO)
|
$29.00 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,819.39 |
Browse Plan Formulary |
Humana Gold Plus SNP-DE H2649-015 (HMO)
|
$30.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Advantra Option 3 (HMO)
|
$32.10 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
Care Improvement Plus Silver Rx (Regional
|
$33.20 |
$0 | to be determined | 4 |
Tier 4 |
33% | 33% | None | $1,799.91 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Ozark Health Plan - Enhanced (HMO)
|
$34.30 |
$310 | to be determined | 5 |
Tier 5 |
25% | 25% | None | $1,855.62 |
Browse Plan Formulary |
Advantra Option 2 (HMO)
|
$35.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,866.02 |
Browse Plan Formulary |
HumanaChoice H1716-006 (PPO)
|
$38.70 |
$0 | to be determined | 4 |
Tier 4 |
33% | n/a | P | $1,857.74 |
Browse Plan Formulary |