Prescription Drug Coverage
Generic
Formulary
Non-Formulary
Specialty
|
$15 Copay
Deductible, then $35 Copay
Deductible, then $65 Copay
Deductible, then 20% up to $250
|
$37.50 Copay
Deductible, then $87.50 Copay
Deductible, then $162.50 Copay
Not Available
|