|
DEDUCTIBLE
(The amount you pay before your plan starts to pay)
You Pay
|
INITIAL COVERAGE
$0-$4,275
You Pay
|
COVERAGE GAP
Over $4,275
You Pay
|
CATASTROPHIC
Over $7,050
You Pay
|
---|
Tier 1 Preferred Generic Drugs |
No Deductible |
$2 |
25% of the cost |
$3.95 or 5% of the cost |
Tier 2 Generic Drugs |
No Deductible |
$15 |
25% of the cost |
$3.95 or 5% of the cost |
Tier 3 Preferred Brand Drugs |
$325 |
$42 |
25% of the cost |
$9.85 or 5% of the cost |
Tier 4 Non-Preferred Drugs |
$325 |
$95 |
25% of the cost |
$3.95, $9.85 or 5% of the cost |
Tier 5 Specialty Drugs |
$325 |
27% of the cost |
25% of the cost |
$3.95, $9.85 or 5% of the cost |
You will pay the above cost-sharing when you use preferred pharmacies. You pay more when you use standard pharmacies. You may pay less if you get Extra Help. $0 Tier 1 and 2 generics are available through preferred mail order
Set up Home Delivery and Refills for Prescription Drugs
Have your prescriptions and refills delivered directly to your home through Express Scripts, Inc. (ESI), our home-delivery pharmacy.
Additional Pharmacy Information
Learn more about how to get money back for a drug, our Medication Management Therapy program, how to get help paying for Part D drugs through the Extra Help program (as known as Low-Income Subsidy), and much more.