Prescriptions
|
You pay
|
Retail Rx
|
Preferred generic1: $10 Nonpreferred generic1: 25% ($250 max) Preferred brand: $25 Nonpreferred brand: $75
|
Home delivery Rx
|
Preferred generic1: $20 Nonpreferred generic1: 25% ($500 max) Preferred brand: $50 Nonpreferred brand: $150
|
Cost Share amounts listed in the chart are for service performed at in-network providers.
1 Deductible waived for generic drugs