|Effective October 1, 2017||What you pay|
|Certain preventive drugs/supplies||FREE|
|Generic drugs on the formulary||$1|
|Brand name drugs on the formulary||$8|
|Specialty brand or biosimilar drugs||
Generic: $5 copay
|Drugs not on the formulary||Not Covered|
|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: (844) 813-3860
Out of Network
Certain independent local pharmacies
Remember: Don't go out of network, you will pay 100% of the cost!