Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
|
Retail 30 Day Supply
Deductible then, $10 Copay
Deductible then, $25 Copay
Deductible then, $75 Copay
Deductible then, $150 Copay
|
Mail Order 90 Day Supply
Deductible then, $20 Copay
Deductible then, $50 Copay
Deductible then, $150 Copay
Not Available
|