|What you pay
When you use a network or mail order pharmacy
|Certain preventive drugs/supplies||$0|
|Generic drugs||$15 copay|
|Preferred brand name drugs||$25 copay|
|Non-preferred brand name drugs||$35 copay|
|Mail order||$10 copay|
|Specialty brand or biosimilar drugs||25% coinsurance ($35 max copay)
|Existing out-of-pocket limits continue to apply.|
Brand name drug with generic available
If you or your healthcare provider insist on a brand name drug when a generic equivalent is available, you must pay the generic copay plus the difference in cost between the brand and generic drug.
If the generic copay is $10, the brand name drug is $80 and the generic is $50, you will pay $40. $10 copay plus $30 difference in cost.
For questions about your drug benefits, call: (866) 686-0003
Out of Network
Martins/Giant/Stop & Shop
Kroger/Fred Meyer/Fry's/King Soopers
Certain independent local pharmacies
Remember: Don't go out of network, you will pay 100% of the cost!