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Prescription Plans At a Glance

2024/25 in-network plans

for short term medications (up to a 30 day supply)
	Blue (Traditional) Plan	Orange (HDHP) Plan
Deductible	Not applicable.	Pharmacy costs combine with medical plan deductibles.
Maximum out of pocket	Pharmacy co-pays combine with medical plan limits	Pharmacy co-pays combine with medical plan limits
preventive drug per aca guidelines	$0 copay	$0 copay
in-network retail pharmacy network	Not subject to deductible. $10 generic copay $40 preferred brand copay $80 non-preferred brand copay 30% coinsurance (with optional $0 co-pay if enrolled in the Prudent Rx Co-Pay Program), specialty drugs	After deductible. $10 generic copay $40 preferred brand copay $80 non-preferred brand copay 30% coinsurance (with optional $0 co-pay if enrolled in the Prudent Rx Co-Pay Program), specialty drugs
for long term maintenance medications (up to a 90 DAY SUPPLY)
CVS or Target retail pharmacy or CVS/Caremark mail service pharmacy	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 in-network retail pharmacies	Not eligible in plan; expense will be 100% employee cost	Not eligible in plan; expense will be 100% employee cost
Benefits at a glance	Blue RX BAAG	Orange RX BAAG