[ HEALTH ]
PHARMACY BENEFITSHere are your benefits for prescription drug coverage:
| Pharmacy Coverage | Bioequivalent Preferred | Bioequivalent Non-Preferred | Brand Preferred | Brand Non-Preferred |
|---|---|---|---|---|
| Point of Service | $5.00 | $5.00 | 20% Min. $10 Max. $40 | 20% Min. $10 Max. $40 |
| Retail 90 Days’ Supply* | $10.00 | $10.00 | 20% Min. $20 Max. $80 | 20% Min. $20 Max. $80 |
| Mail Order* | $10.00 | $10.00 | 20% Min. $20 Max. $80 | 20% Min. $20 Max. $80 |
| Specialty Drugs Program | 20% | 20% | 20% | 20% |
| Over the Counter Drugs (OTC) $1.00 | ||||
| Oral Chemotherapy 0% | ||||
*Maintenance Drug Only
