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Region 30 - Oregon, Washington


Advantage Star Plan
TierNameCo-pay
Tier 1Generics $5.25 co-pay
Tier 2 Preferred Brand 25% co-pay
Tier 3 Specialty25% co-pay
Tier 4 Non-Preferred 45% co-pay
Monthly Premium: $34.80
Advantage Freedom Plan
TierNameCo-pay
Tier 1 Generics$5 co-pay
Tier 2 Preferred Brand 35% co-pay
Tier 3 Specialty 33% co-pay
Tier 4 Non-Preferred 45% co-pay
Monthly Premium: $34.40




Star MaterialsFreedom Materials
Comprehensive Formulary*Comprehensive Formulary*
Summary of Benefits*Summary of Benefits*
Evidence of Coverage*Evidence of Coverage*








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