|What you pay
When you use a nework or mail order pharmacy
|Certain preventive drugs/supplies||$0|
|Generic drugs||$10 copay|
|Preferred brand name drugs||$30|
|Non-preferred brand name drugs||50% coinsurance ($100 max copay)|
|Mail order||Generic - $20 | Preferred - $60
Non-preferred - 50% coinsurance ($200 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
|View your network pharmacies here||Wal-Mart
Certain independent local pharmacies
Remember: Don't go out of network, you will pay 100% of the cost!