PHARMACY
Our plan uses TrueRx for prescriptions.
Premium is included in the health plan cost shown on the medical page.
Prescription Highlights (In-Network)
HDHP Plan
Retail Pharmacy (30-day supply)
Tier 1 - Generic
Deductible, then $15 copay
Tier 2 - Brand Name Formulary
Deductible, then $30 copay
Tier 3 - Brand Name Non-Formulary
Deductible, then $60
Tier 4 - Specialty Medication
Deductible, then you pay 20%
Mail-Order Pharmacy (90-day supply)
Tier 1 - Generic
Deductible, then $30 copay
Tier 2 - Brand Name Formulary
Deductible, then $60 copay
Tier 3 - Brand Name Non-Formulary
Deductible, then $120 copay
Tier 4 - Specialty Medication
Deductible, then you pay 20%
PPO Plan
Retail Pharmacy (30-day supply)
Tier 1 - Generic
$15 copay
Tier 2 - Brand Name Formulary
$30 copay
Tier 3 - Brand Name Non-Formulary
$60 copay
Tier 4 - Specialty Medication
20%
Mail-Order Pharmacy (90-day supply)
Tier 1 - Generic
$30 copay
Tier 2 - Brand Name Formulary
$60 copay
Tier 3 - Brand Name Non-Formulary
$120 copay
Tier 4 - Specialty Medication
20%
Questions about your prescription benefits? TrueRx Customer Service: (866) 921-4047, www.truerx.com TrueRx Pharmacist Help Desk: (833) 202-8783
True Rx online access & mobile app:
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