Prescription Drugs
| Type of Drug | Network Retail Pharmacy
(up to 90-day supply) | Mail Service Pharmacy
(up to 90-day supply) |
|---|
| Generic |
$5 copay or 10% coinsurance, whichever is greater |
$5 copay or 10% coinsurance, whichever is greater |
| Preferred Brand |
$20 copay or 10% coinsurance, whichever is greater |
$20 copay or 10% coinsurance, whichever is greater |
| Brand |
$40 copay or 10% coinsurance, whichever is greater |
$40 copay or 10% coinsurance, whichever is greater |
In the PPOs, you can go to a non-network pharmacy and pay 50% of the eligible cost. (Non-network coverage is not available in the EPOs).
The annual out-of-pocket maximum for prescription drugs:
- In the PPOs - $2,000/individual and $4,000/family
- In the EPOs - $1,500/individual and $3,000/family