|
2009 Prescription Drug Plan Co-Pays |
Group |
Drug Type |
Retail Pharmacy Co-Pay 1, 2
(up to a 34-day supply ) |
Walgreens Mail Service Pharmacy
Co-Pay 1 (up to a 90-day supply ) |
| Faculty, Staff, Retirees and their dependents except as noted below. |
Generic Drugs/Tier 1 |
$5 |
$10 |
Brand-Name Drugs / Tier 2 |
$15 |
$30 |
Non-Preferred Drugs (Brand-name) Tier 3 |
$30 |
$60 |
AFSCME (Active or LTD members [per contract]) |
Generic Drugs/Tier 1 |
$5 |
$10 |
Brand Name Drugs/Tier 2 |
$14 |
$28 |
Non-Preferred Drugs (Brand name) /Tier 3 |
$24 |
$48 |
IUOE (Active or LTD members [per contract]) |
Generic Drugs/Tier 1 |
$7 |
$14 |
Brand-Name Drugs/Tier 2 |
$14 |
$28 |
Non-preferred Drugs (Brand-Name)/Tier 3 |
$24 |
$48 |
Trades (Active or LTD members [per contract])
|
Generic Drugs/Tier 1 |
$5 |
$10 |
Brand-Name Drugs / Tier 2 |
$15 |
$30 |
Non-Preferred Drugs (Brand-name) Tier 3 |
$30 |
$60 |
1 Catastrophic coverage for prescription drugs goes into effect after the annual out-of-pocket maximum of $2,500 per individual coverage or $5,000 per family per year is met. Catastrophic coverage applies only to covered prescription drugs and does not include infertility medications, generic drug incentive or medical plan expenses such as doctor office visits.
2 If the retail price of a covered medication is less than the tier co-pay, you pay only the cost of the medication. If the cost of the covered medication is more than the co-pay, you pay only the co-pay. The member always pays the full cost for prescriptions that are not covered by the plan.
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