Drug Type | Retail Copay | Mail Order Copay | Additional Info |
|---|---|---|---|
Preferred Generic drugs | $12 copay | $24 copay | $75 individual preventive prescription deductible if Base Coverage deductible isn't met. Mail Order 60-90 day supply. |
Non-Preferred Generic drugs | $30 copay | $60 copay | You pay 100%, then seek reimbursement minus deductible/copay. Check for needed approvals. |
Preferred brand drugs | $45 copay | $90 copay | No charge for FDA-approved generic contraceptives if medically needed. Brand choice requires difference payment. |
Non-preferred brand drugs | $100 copay | $200 copay | Choose brands with generics means paying cost difference plus copay. Prior approvals might be needed. |
Specialty drugs | $100 copay | Not covered | Specialty drugs have specific requirements. Confirm coverage details. |
Drug Type | Retail Copay | Mail Order Copay |
|---|---|---|
Non-Preferred Generic drugs | $30 copay | $60 copay |
Preferred brand drugs | $45 copay | $90 copay |
Non-preferred brand drugs | $100 copay | $200 copay |
Specialty drugs | $100 copay | Not covered |