[ { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010060", "marketing_name": "Essential Bronze HMO $8700 $75 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010060-01-b-essential--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 100.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 100.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 300.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 250.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010061", "marketing_name": "Essential Bronze HMO $8700 $75 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010061-01-b-essential-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 100.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 100.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 300.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 250.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010062", "marketing_name": "Enhanced Diabetes Bronze HMO $8700 $0 Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010062-01-b-enhanced-d--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010063", "marketing_name": "Enhanced Diabetes Bronze HMO $8700 $0 Adult Dental Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010063-01-b-enhanced-d-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010064", "marketing_name": "Enhanced Blood Pressure Management Bronze HMO $8700 $0 Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010064-01-b-enhanced-bpm--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010065", "marketing_name": "Enhanced Blood Pressure Management Bronze HMO $8700 $0 Adult Dental Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010065-01-b-enhanced-bpm-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010070", "marketing_name": "Essential Silver HMO $7500 $0 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010070-01-s-essential--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010071", "marketing_name": "Essential Silver HMO $7500 $0 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010071-01-s-essential-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010072", "marketing_name": "Enhanced Diabetes Silver HMO $7500 $0 Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010072-01-s-enhanced-d--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010073", "marketing_name": "Enhanced Diabetes Silver HMO $7500 $0 Adult Dental Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010073-01-s-enhanced-d-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010074", "marketing_name": "Enhanced Blood Pressure Management Silver HMO $7500 $0 Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010074-01-s-enhanced-bpm--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010075", "marketing_name": "Enhanced Blood Pressure Management Silver HMO $7500 $0 Adult Dental Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010075-01-s-enhanced-bpm-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010080", "marketing_name": "Essential Gold HMO $4000 $0 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010080-01-g-essential--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010081", "marketing_name": "Essential Gold HMO $4000 $0 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010081-01-g-essential-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010082", "marketing_name": "Enhanced Diabetes Gold HMO $3000 $0 Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010082-01-g-enhanced-d--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010083", "marketing_name": "Enhanced Diabetes Gold HMO $3000 $0 Adult Dental Unlimited Free Antidote Virtual Visits and Select $0 Insulin", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010083-01-g-enhanced-d-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010084", "marketing_name": "Enhanced Blood Pressure Management Gold HMO $3000 $0 Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010084-01-g-enhanced-bpm--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010085", "marketing_name": "Enhanced Blood Pressure Management Gold HMO $3000 $0 Adult Dental Unlimited Free Antidote Virtual Visits and $0 Advanced Rx List", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010085-01-g-enhanced-bpm-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.35, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010110", "marketing_name": "Complete Bronze HMO $8700 $0 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010110-01-b-complete--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010111", "marketing_name": "Complete Bronze HMO $8700 $0 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010111-01-b-complete-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.5, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010120", "marketing_name": "Complete Silver HMO $7500 $0 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010120-01-s-complete--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010121", "marketing_name": "Complete Silver HMO $7500 $0 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010121-01-s-complete-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010130", "marketing_name": "Complete Gold HMO $3500 $0 Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010130-01-g-complete--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010131", "marketing_name": "Complete Gold HMO $3500 $0 Adult Dental Unlimited Free Antidote Virtual Visits", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010131-01-g-complete-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010210", "marketing_name": "Elite Bronze HMO $8000 $0 Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010210-01-b-elite--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010211", "marketing_name": "Elite Bronze HMO $8000 $0 Adult Dental Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010211-01-b-elite-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 25.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 62.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 225.0, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 187.5, "copay_opt": "AFTER-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.4, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010220", "marketing_name": "Elite Silver HMO $6500 $0 Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010220-01-s-elite--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010221", "marketing_name": "Elite Silver HMO $6500 $0 Adult Dental Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010221-01-s-elite-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 45.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 37.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 50.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 150.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 125.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.3, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010230", "marketing_name": "Elite Gold HMO $3000 $0 Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010230-01-g-elite--on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" }, { "plan_id_type": "HIOS-PLAN-ID", "plan_id": "10243GA0010231", "marketing_name": "Elite Gold HMO $3000 $0 Adult Dental Unlimited Free Antidote Virtual Visits with $0 Lab Referrals", "summary_url": "https://antidotehealth.com/assets/docs/27/m-27-ga-en-ifp-sbc-10243GA0010231-01-g-elite-d-on.pdf", "marketing_url": "https://antidotehealth.com/assets/docs/27/m-pb-27-ga-en-es-ifp.pdf", "formulary_url": "https://www.antidotehealth.com/insurance/find-medications/ga", "plan_contact": "gaplancontact@antidotehealth.com", "years": [ 2026 ], "network": [ { "network_tier": "TIERONE" }, { "network_tier": "TIERTWO" } ], "formulary": [ { "drug_tier": "ZERO-COST-SHARE-PREVENTIVE", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": "NO-CHARGE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "GENERIC", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 5.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 15.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 12.5, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 30.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 90.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 75.0, "copay_opt": "BEFORE-DEDUCTIBLE", "coinsurance_rate": 0.0, "coinsurance_opt": null } ] }, { "drug_tier": "NON-PREFERRED-BRAND", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] }, { "drug_tier": "SPECIALTY", "mail_order": true, "cost_sharing": [ { "pharmacy_type": "1-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "1-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-RETAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" }, { "pharmacy_type": "3-MONTH-IN-MAIL", "copay_amount": 0.0, "copay_opt": null, "coinsurance_rate": 0.2, "coinsurance_opt": "AFTER-DEDUCTIBLE" } ] } ], "last_updated_on": "2026-08-28" } ]