Copayments and a separate deductible apply to prescription drug coverage. To achieve maximum savings, choose generic drugs and mail order services whenever possible. The Food and Drug Administration requires that generic equivalent medications have the same quality, safety and effectiveness as their brand name counterparts.
| Retail Pharmacies |
|
| Copayments |
|
- Generic drugs up to a 30-day supply
| $10
|
- Brand name drugs up to a 30-day supply
| 25% of the total cost.
|
- Brand name with generic equivalent up to a 30-day supply
| 25% of the total cost, plus entire difference in cost between brand name and generic.
|
Mail Order Pharmacies
|
|
| Copayments |
|
- Generic drugs up to a 90-day supply
| $30
|
- Brand name drugs up to a 90-day supply
| 25% of the total cost, with a $150 maximum per prescription.
|
- Brand name drugs with generic equivalent up to a 90-day supply
| 25% of the total cost, with a $150 maximum per prescription, plus the entire difference in cost between brand name and generic.
|
All pharmacies
|
|
| Annual out-of-pocket maximum | $2,000¹ plus deductible.
|
1 The difference in cost between Brand Name Drugs and their Generic Equivalents (when they are available) is considered a non-covered expense. When participants elect to purchase Brand Names over available Generic Equivalents they are responsible for the cost differential. Such costs are not included in the Out-of-Pocket Maximum.
See pages 48-49 of the 2005 Health Plan Summary Plan Description and relevant Benefits Updates for additional information and details. The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents. If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.