Select Drug Plan Options |
|||||||
| Option 1 $10/$20/ $35 |
Option 2 (NEW) $10/$40/ $70 |
Option 3 (NEW) $10/$45/ $75 |
Option 4 $15/$35/ $50 |
Option 5 $20/$40/ $60 |
Option 6 (NEW) $250/$10/ $45/$75 |
Option 7 $250/$20/ $40/$60 |
|
| Deductible1 | N/A | N/A | N/A | N/A | N/A | $250 (waived for generics) |
$250 |
| Generic formulary | $10 | $10 | $10 | $15 | $20 | $10 | $20 |
| Brand formulary | $20 | $40 | $45 | $35 | $40 | $45 | $40 |
| Non-formulary brand | $35 | $70 | $75 | $50 | $60 | $75 | $60 |
Basic Drug Plan Options |
||
| Option 8 $7/50% ($125) |
Option 9 $4/brand discount3 |
|
| Deductible | N/A | N/A |
| Generic | $7 | $4 |
| Brand2 | 50% of discounted price up to $125 (maximum member payment per prescription) | Discount available |
1 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 network.
2 Brand drugs vary in cost, and cost sharing is based on a discounted amount that was negotiated with the pharmacy.ug Program® options.
3 Not creditable coverage under Medicare Part D