Prescription Drug Copays

If you are enrolled in health care benefits, you will pay these copays for prescription drugs:

Prescription Drug Plan Network Pharmacies Copay up to 30-Day Supply Home Delivery Copay up to 90-Day Supply Option 1 Generic You pay $10 You pay $20 Option 2 Formulary You pay $40 You pay $80 Option 3 Non-formulary You pay $55 You pay $110

Generic: A drug that is chemically equivalent to a brand drug for which the patent has expired. The color and shape of the drug may be different, but the active ingredients are the same. Generic medications, created after the patent expires on an original, patented drug, are required to meet the same quality standards as brand drugs.

Formulary: A brand-name drug (an original, patented drug created by a single manufacturer) that is listed on your formulary.

Non-formulary: A brand-name drug (an original, patented drug created by a single manufacturer) that is not listed on your formulary.

Specialty Medications: Specialty medications covered under your prescription drug plan require a 20 percent copay with a maximum out-of-pocket of $150 per prescription. Your annual maximum out-of-pocket for specialty medications will be $2,000 per member and $4,000 per family. The maximum days supply for your specialty medications is 30 days.

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