|What you pay
When you use a network or mail order pharmacy
|Certain preventive drugs/supplies||$0|
|Generic drugs||$10 copay|
|Preferred brand name drugs||$20 copay|
|Non-preferred brand name drugs||$50 copay|
|Specialty brand or biosimilar drugs (effective June 1, 2016)||25% coinsurance
($50 max copay)
|Existing out-of-pocket limits continue to apply. Remember, Class II pharmacy benefits are limited to certain preventive drugs/supplies only.|
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
Martins/Giant/Stop & Shop
Kroger/Fred Meyer/Fry's/King Soopers
Remember: Don't go out of network, you will pay 100% of the cost!