Fyavolv
Generic: ethinyl estradiol
0.5 Mg, 2.5 Mcg — Tablet
Also known as:
fyavolv tab 0.5-2.5
fyavolv tab 1-5
ethinyl estradiol
Fyavolv 0.5 Mg-2.5 Mcg Tablet
Fyavolv 1 Mg-5 Mcg Tablet
Fyavolv Tab 0.5-2.5
Fyavolv Tab 1-5
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Ambetter (Centene)
116 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Elite Bronze with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Silver with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Focused Silver with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via ethinyl estradiol |
Tier 0 - $0 Preventive | — | — | — | None |
|
Standard Gold
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Clear Silver with $0 Insulin Options
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Gold with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Silver with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Standard Expanded Bronze with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Complete Gold with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Focused Silver with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Elite Bronze with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
|
Everyday Bronze with Atrium Health
via Twirla |
Tier 0 - $0 Preventive | — | — | ✓ | QL |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options | Tier 2 - Generic | — | — | — | None |
| Complete Gold | Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Silver + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Elite Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Complete Gold + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental | Tier 2 - Generic | — | — | — | None |
| Standard Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Complete Gold with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Focused Silver with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Elite Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze with Atrium Health | Tier 2 - Generic | — | — | — | None |
| Standard Gold | Tier 2 - Generic | — | — | — | None |
| Standard Silver | Tier 2 - Generic | — | — | — | None |
| Standard Expanded Bronze | Tier 2 - Generic | — | — | — | None |
| Clear Silver with $0 Insulin Options | Tier 2 - Generic | — | — | — | None |
| Elite Bronze | Tier 2 - Generic | — | — | — | None |
| Everyday Bronze | Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Clear Silver with $0 Insulin Options
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Everyday Bronze
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Gold + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Silver + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Standard Expanded Bronze + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Complete Gold with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health + Vision + Adult Dental
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Elite Bronze with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Focused Silver with Atrium Health
via Jinteli |
Tier 2 - Generic | — | — | — | None |
Blue Cross Blue Shield Federal
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
BCBS Federal Focus 2026
via Jinteli |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Focus 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Basic Option 2026
via Jinteli |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Basic Option 2026 | Tier 1 - Generic | — | — | — | None |
|
BCBS Federal Standard Option 2026
via Jinteli |
Tier 1 - Generic | — | — | — | None |
| BCBS Federal Standard Option 2026 | Tier 1 - Generic | — | — | — | None |
Cigna
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Cigna Plus NC 4-Tier Formulary 2026
via Jinteli |
Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Aranelle 28 |
Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Twirla |
Tier 1 - Generic | — | — | — | None |
| Cigna Plus NC 4-Tier Formulary 2026 | Tier 1 - Generic | — | — | — | None |
|
Cigna Plus NC 4-Tier Formulary 2026
via Sprintec 28 Day |
Tier 1 - Generic | — | — | — | None |
Medicare Part D
10443 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
PruittHealth Premier (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Aranelle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Aranelle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Rosyrah 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Rosyrah 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Rosyrah 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Iclevia 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Rivelsa 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Rivelsa 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Rivelsa 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Dual Plan (HMO D-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Dual Plan (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Liberty Medicare Advantage Nursing Home Plan (HMO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Jaimiess 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
| PruittHealth Premier (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Aranelle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
PruittHealth Premier (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
PruittHealth Premier (HMO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Briellyn 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
| NHC Advantage (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Aranelle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
NHC Advantage (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Marlissa 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Mili 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Aubra 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Larin 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Setlakin 91 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Falmina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Levonest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Aranelle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Aviane 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tri-Legest 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Cryselle 28 |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
Longevity Health Plan (HMO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
NHC Advantage (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via ethinyl estradiol |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Estarylla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Vienva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Introvale 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Altavera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Ashlyna 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Turqoz 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Vyfemla 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Sronyx 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Lutera 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Dolishale 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Dolishale 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Dolishale 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Balziva 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Portia 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Sprintec 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Lessina 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Community Plan (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Advantage Plan (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 1 - Preferred Generic | — | — | — | None |
|
Provider Partners North Carolina Essential Plan (HMO I-SNP)
via CamreseLo 91 Day |
Tier 1 - Preferred Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Merzee 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
| Troy Medicare (HMO) | Tier 2 - Generic | — | — | — | None |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
| Senior Care (HMO I-SNP) | Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Minzoya 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Senior Care (HMO I-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Senior Care (HMO I-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Merzee 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Merzee 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Merzee 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Merzee 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Alignment Health AVA (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Troy Medicare (HMO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xelria Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Feirza 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Rosyrah 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Valtya 1/50 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Galbriela 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Feirza 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Introvale 91 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Jinteli |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
| Liberty Medicare Advantage (HMO C-SNP) | Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Introvale 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Jaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 91 days | QL |
|
Liberty Medicare Advantage (HMO C-SNP)
via ethinyl estradiol |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Liberty Medicare Advantage (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Turqoz 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Xarah Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Nortrel 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tri-Legest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Microgestin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Microgestin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Zovia 1/35E 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Larin 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Loestrin 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 2 - Generic | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tarina 24 FE 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tarina Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Loestrin Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Lutera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Levora 0.15/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Sronyx 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Low-Ogestrel 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Cryselle 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Gemmily 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Lo-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Junel Fe 24 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via CamreseLo 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nortrel 0.5/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Nortrel 1/35 21 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Tri-Sprintec 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Portia 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Junel Fe 1/20 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Aviane 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Kelnor 1/35 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Aranelle 28 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Levonest 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Falmina 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5216-211 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Full Access H5525-034 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-050 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-070 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via Setlakin 91 Day |
Tier 2 - Generic | — | — | ✓ 91 per 90 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Aubra 28 Day |
Tier 2 - Generic | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CORE 001 NC (HMO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H1036-233 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice Giveback H5216-017 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice H5216-211 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Full Access H5525-034 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
| DEVOTED CORE 001 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice H5525-050 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
DEVOTED CORE 001 NC (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 002 NC (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED GIVEBACK 012 NC (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 001 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 002 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 003 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 004 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 005 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 006 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE 008 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED CHOICE GIVEBACK 009 NC (PPO)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice H5525-083 (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H6622-025 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H6622-026 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H6622-057 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H6622-060 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
Humana Gold Choice H8145-004 (PFFS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
|
HumanaChoice H5525-083 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Chronic Care Value (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring True Choice (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring True Choice (PPO)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Merzee 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Merzee 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nortrel 1/35 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nortrel 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nortrel 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Lessina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Wymzya Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Kaitlib Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Mibelas 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Nortrel 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Dual (HMO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Value Plus (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Prime (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Care (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Full Dual Care (HMO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (HMO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Enhanced (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Extra (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature Giveback (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Aetna Medicare Signature (PPO)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Vyfemla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Zovia 1/35E 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Portia 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Junel 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Turqoz 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL FULL 013 NC (HMO D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL PLUS 006 NC (HMO D-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
DEVOTED DUAL 009 NC (HMO D-SNP)
via Jinteli |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-VyLibra Lo 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Hailey 24 Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Introvale 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Gemmily 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Gemmily 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Lojaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Galbriela 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Xarah Fe 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Rosyrah 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Legest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Finzala 24 Fe Chewable 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via CamreseLo 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Rivelsa 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Tri-Lo-Sprintec 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health smartHMO (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum Select (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health AVA (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | ✓ 3 per 28 days | QL |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Junel Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Junel Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Balziva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Aviane 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Briellyn 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Marlissa 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Cryselle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Larin 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Aubra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tarina Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tri-VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via VyLibra 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Dolishale 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Lutera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Levora 0.15/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Sronyx 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Low-Ogestrel 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nylia 7/7/7 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Nylia 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Altavera 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Vienva 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Kelnor 1/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Aranelle 28 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Levonest 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Loestrin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Loestrin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Loestrin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Loestrin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Mili 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Iclevia 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Blisovi 21 Fe 1.5/30 28 Day Pack |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred (HMO)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Select (HMO)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Savings (HMO)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring Preferred Plus (HMO)
via Joyeaux 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Ashlyna 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Lo- Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Estarylla 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Jaimiess 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Microgestin Fe 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Microgestin Fe 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Microgestin 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Microgestin 1/20 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Necon 0.5/35 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Valtya 1/50 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Feirza 1/20 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Feirza 1.5/30 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Luizza 1.5/30 21 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Alignment Health Platinum (HMO)
via ethinyl estradiol |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Larin Fe 1.5/30 |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Setlakin 91 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare Plus (HMO D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
HealthSpring TotalCare (HMO D-SNP)
via Falmina 28 Day |
Tier 3 - Preferred Brand | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Jaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan II (PPO)
via Jaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Iclevia 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan II (PPO)
via Iclevia 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Iclevia 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Jaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Rosyrah 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Iclevia 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Setlakin 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Jaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Rosyrah 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Blisovi 24 Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Hailey 24 Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Rivelsa 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Introvale 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Ashlyna 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Blue Medicare PPO Enhanced (PPO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Lojaimiess 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Ashlyna 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Ashlyna 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
via Ashlyna 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Rosyrah 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan II (PPO)
via Rosyrah 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HumanaChoice Giveback H5525-035 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| HealthTeam Advantage Plan II (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthTeam Advantage Vitality Plan (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Introvale 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Vitality Plan (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Larin Fe 1.5/30 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Larin Fe 1.5/30 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Rivelsa 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan II (PPO)
via Rivelsa 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Rivelsa 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan I (PPO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HumanaChoice H5525-049 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Larin Fe 1.5/30 |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Plan II (PPO)
via Introvale 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via Setlakin 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-25 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-27 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Complete Care NC-28 (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Champion (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-049 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| UHC Nursing Home Plan NC-F001 (PPO I-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S001 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S2 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage Access from UHC NC-23 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0001 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0004 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0016 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0017 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0019 (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0021 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0022 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0007 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-D001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0008 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0009 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0011 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0012 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-V001 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-0015 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| UHC Dual Complete NC-S3 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-24 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| AARP Medicare Advantage from UHC NC-26 (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Signature (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Guardian (HMO-POS I-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Freedom (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Erickson Advantage Liberty (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Kaitlib Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple Open (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-050 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Briellyn 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-070 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H5525-072 (PPO D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5525-083 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-025 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-026 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H6622-027 (HMO-POS D-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan I (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-057 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-060 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Giveback Open (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Femlyv 24 ODT 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5525-035 (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice SNP-DE H5525-036 (PPO D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Junel Fe 24 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-25 (HMO-POS C-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-27 (HMO-POS C-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Complete Care NC-28 (HMO-POS C-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Champion (HMO-POS C-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via CamreseLo 91 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Dolishale 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HealthTeam Advantage Plan II (PPO)
via Setlakin 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Setlakin 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
|
HealthTeam Advantage Vitality Plan (PPO)
via Introvale 91 Day |
Tier 4 - Non-Preferred | — | — | ✓ 91 per 91 days | QL |
| HealthTeam Advantage Plan I (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H6622-061 (HMO-POS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Choice H8145-004 (PFFS)
via Wymzya Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-137 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-233 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Dual Select H1036-307 (HMO D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Aranelle 28 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Aranelle 28 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Balziva 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Aranelle 28 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential (HMO)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Experience Health Medicare Advantage (HMO)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Galbriela 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Nursing Home Plan NC-F001 (PPO I-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S001 (PPO D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S2 (PPO D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Access from UHC NC-23 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0001 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0004 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0016 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0017 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0019 (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0021 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0022 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0007 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-D001 (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0008 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0009 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0011 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0012 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-13 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage Giveback from UHC NC-14 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-V001 (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-0015 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
UHC Dual Complete NC-S3 (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-24 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
AARP Medicare Advantage from UHC NC-26 (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Signature (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Guardian (HMO-POS I-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Freedom (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Erickson Advantage Liberty (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Aranelle 28 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus Giveback H1036-318 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Gold Plus H1036-335 (HMO-POS)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice Giveback H5216-017 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
HumanaChoice H5216-211 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Humana Full Access H5525-034 (PPO)
via Vyfemla 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare PPO Enhanced (PPO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Essential Plus (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Enhanced (HMO-POS)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Blue Medicare Choice (HMO)
via Xelria Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Aranelle 28 |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nortrel 0.5/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nortrel 1/35 21 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nortrel 1/35 21 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nortrel 1/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nortrel 1/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nortrel 1/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Nortrel 7/7/7 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nortrel 7/7/7 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple (HMO-POS)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tarina 24 FE 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty Open (PPO D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Assist Open (PPO)
via Tarina Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Xarah Fe 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Access (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Liberty (HMO-POS D-SNP)
via Tarina Fe 1/20 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Simple Open (PPO)
via ethinyl estradiol |
Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Tri-Legest 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Jinteli |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nortrel 0.5/35 28 Day |
Tier 4 - Non-Preferred | — | — | — | None |
|
Wellcare Dual Reserve (HMO-POS D-SNP)
via Nortrel 1/35 21 Day |
Tier 4 - Non-Preferred | — | — | — | None |
NC Medicaid PDL
2 plansNC State Health Plan
6 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - HDHP 2026 | Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 80/20 Plus PPO 2026
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Jinteli |
Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 80/20 Plus PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 1 - Preferred Generic | — | — | — | None |
UnitedHealthcare
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UnitedHealthcare NC Individual & Family 2026
via Twirla |
Tier 1 - $0 Copay Preventive | — | — | — | None |
|
UnitedHealthcare NC Individual & Family 2026
via Jinteli |
Tier 3 - Mid-Range Cost | — | — | — | None |
| UnitedHealthcare NC Individual & Family 2026 | Tier 3 - Mid-Range Cost | — | — | — | None |