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

When you get care, as soon as your medical and pharmacy bills reach your deductible, your plan will start sharing the cost. This plan's in-network deductible is:

  • $3,500 for an individual
  • $7,000 for a family (two or more members)
Drug tier When you pay What you pay
Tier 1 - Generic Before deductible All costs
After deductible $15
Tier 2 - Preferred brand Before deductible All costs
After deductible No more than $100
Tier 3 - Nonpreferred brand Before deductible All costs
After deductible No more than $100
Tier 4 - Preferred specialty Before deductible All costs
After deductible No more than $200
Tier 5 - Nonpreferred specialty Before deductible All costs
After deductible 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.