Prescription Plans At a Glance
2018/19 in-network plans
Blue (Traditional) Plan | Orange (HDHP) Plan | |
---|---|---|
preventive drug per aca guidelines | $0 copay | $0 copay |
CVS/Caremark retail pharmacy network (up to a 30-day supply) | Not subject to deductible. $10 generic copay $40 preferred brand copay $80 non-preferred brand copay 10% coinsurance up to $120 maximum |
After deductible. $10 generic copay $40 preferred brand copay $80 non-preferred brand copay 10% coinsurance up to $120 maximum |
CVS or Target retail pharmacy or CVS/Caremark mail service pharmacy (FOR A 31–90 DAY SUPPLY) | Not subject to deductible. $20 generic copay $80 preferred brand copay $160 non-preferred brand copay Specialty drugs not eligible, due to maximum 30-day supply limit. |
After deductible. $20 generic copay $80 preferred brand copay $160 non-preferred brand copay Specialty drugs not eligible, due to maximum 30-day supply limit. |
All other retail pharmacies participating in retail 90 network (for a 31–90 day supply delivered to your home) | Not subject to deductible. $25 generic copay $100 preferred brand copay $200 non-preferred brand copay Specialty drugs not eligible, due to maximum 30-day supply limit. |
After deductible. $25 generic copay $100 preferred brand copay $200 non-preferred brand copay Specialty drugs not eligible, due to maximum 30-day supply limit. |
Maximum out of pocket | Pharmacy co-pays combine with medical plan limits | Pharmacy co-pays combine with medical plan limits |
Deductible | Not applicable. | Pharmacy costs combine with medical plan deductibles. |
Benefits at a glance | Blue RX BAAG | Orange RX BAAG |
PROVIDER INFORMATION
CVS/Caremark
1.888.321.4206