Prescription Services 2020

MyDrugCosts

Standard RX Plan
Retail Pharmacy Co-Payment Amount Mail Order (90 Days)
Generic Drug $15.00 $45.00
Preferred Brand Name Drug $45.00 $135.00
Non-Preferred Brand Name Drug $75.00 $225.00
Specialty Drugs 10% of allowable up to $200 max N/A
(All Co-payment Amounts are per 30-day supply and will not apply to Co-Share Maximum)
Intermediate RX Plan
Retail Pharmacy Co-Payment Amount Mail Order (90 Days)
Generic Drug $15.00 $45.00
Preferred Brand Name Drug $45.00 $135.00
Non-Preferred Brand Name Drug $75.00 $225.00
Specialty Drugs 10% of allowable up to $200 max N/A
(All Co-payment Amounts are per 30-day supply and will not apply to Co-Share Maximum)
Premium RX Plan
Retail Pharmacy Co-Payment Amount Mail Order (90 Days)
Generic Drug $15.00 $45.00
Preferred Brand Name Drug $35.00 $105.00
Non-Preferred Brand Name Drug $55.00 $165.00
Specialty Drugs 10% of allowable up to $200 max N/A
(All Co-payment Amounts are per 30-day supply and will not apply to Co-Share Maximum)