Plan Premium | $28.20 per month |
Deductible | $445 |
Preferred Pharmacy - Initial Coverage Level Copays formulary search | 30-day Supply |
---|---|
Tier 1 - Preferred Generic | $0 |
Tier 2 - Generic | $4 |
Tier 3 - Preferred Brand Name | 10% |
Tier 4 - non-Preferred Drugs | 25% |
Tier 5 - Specialty Tier | 25% |
Standard Pharmacy - Initial Coverage Level Copays formulary search | 30-day Supply |
---|---|
Tier 1 - Preferred Generic | $2 |
Tier 2 - Generic | $8 |
Tier 3 - Preferred Brand Name | 25% |
Tier 4 - non-Preferred Drugs | 25% |
Tier 5 - Specialty Tier | 25% |
You can call our Medicare team at 918-594-5275 for more information on this plan or other options. We are available Monday through Friday from 8:00 to 6:00.