Prescription Drug Coverage
Generic
Preferred brand
Non-Preferred Generics & Brand
Specialty
Expanded Preventive
|
Retail 30-Day Supply
$10 Copay after Deductible
$25 Copay after Deductible
50%* after Ded
$200 Copay after Deductible
Applicable copay above, no Deductible
|
Mail Order 90-Day Supply
$20 Copay after Deductible
$50 Copay after Deductible
50%* after Ded
Not Available
Applicable coinsurance above, no Deductible
|