/ Human Resources

Prescription Plans At a Glance

2017/18 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