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Flex Series

Prescription Drug Coverages


Choose prescription drug benefits. (optional)

With Flex Series, you can choose from one of our popular Select Drug Program® options. The Select Drug Program uses a prescription drug formulary and provides coverage based on a three-tier copayment incentive (e.g. $10 generic formulary/$20 brand formulary/$35 non-formulary brand). Members pay less when using formulary medications, but have access to covered non-formulary medications with a higher copayment.


Prescription Drug Coverages

Option 1

Option 2

Option 3

Option 4

Option 5

Option 6
Retail–up to a 30-day supply* $10/$20/$35 $0/$25/$50 $5/$40/$60 $15/$35/$50 $20/$40/$60 $250/$20/40/60
Deductible** $0 $0 $0 $0 $0 $250
Generic Formulary Copayment $10 $0 $5 $15 $20 $20
Brand Formulary Copayment $20 $25 $40 $35 $40 $40
Non-Formulary Brand Copayment $35 $50 $60 $50 $60 $60

* Mail order–up to a 90-day supply for two retail copayments.
** Deductible is applied per person per calendar year to all covered services purchased in network and out of network through a retail pharmacy or the mail order program.