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Product Details for

 

Mutual of Omaha

Premium

per month for  
Deductible


Initial Coverage Limit

per year

Gap Coverage

(also known as the "donut hole")

Cost Sharing

Tier 1: Preferred Generic

Preferred Pharmacy (30-day)

Standard Pharmacy (30-day)

Mail Order (90-day)

Cost Sharing

Tier 2: Generic

Preferred Pharmacy (30-day)

Standard Pharmacy (30-day)

Mail Order (90-day)

Cost Sharing

Tier 3: Preferred Brand

Preferred Pharmacy (30-day)

Standard Pharmacy (30-day)

Mail Order (90-day)

Cost Sharing

Tier 4: Non-preferred Brand

Preferred Pharmacy (30-day)

Standard Pharmacy (30-day)

Mail Order (30-day)

Cost Sharing

Tier 5: Specialty

Preferred Pharmacy (30-day)

Standard Pharmacy (30-day)

Mail Order (30-day)

Important Plan Documents

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Pharmacy Lookup

Our preferred pharmacy network includes CVS, CVS-Target, Walmart, and local and regional pharmacies.

2021 Pharmacy Finder 2022 Pharmacy Finder

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