In-network pharmacy benefits

These costs are for a one-month supply when you use a retail or mail order pharmacy that accepts this plan. That's called getting your prescription in-network.

Your in-network deductible

This plan has no deductible. That means your plan starts sharing the costs of your covered benefits right away.

Drug tier When you pay What you pay
Tier 1 - Generic Anytime $15
Tier 2 - Preferred brand Anytime No more than $100
Tier 3 - Nonpreferred brand Anytime No more than $100
Tier 4 - Preferred specialty Anytime No more than $200
Tier 5 - Nonpreferred specialty Anytime No more than $300

Out-of-network benefits

You’ll pay the full cost of the drug at the pharmacy. We’ll reimburse you for the covered amount later. Learn more about how this works.