|Medication Category||Cost Per Prescription|
|Up to a 30 Day Supply||Up to a 90 Day Supply|
|Generics (Preferred and Non-Preferred)||$10 copay||$15 copay|
|Brand Name - Preferred||$30 copay||$45 copay|
|Brand Name - Non-Preferred||$45 copay||$70 copay|
|Lifestyle (e.g. Erectile Dysfunction)||$50 copay||$75 copay|
|Specialty||25% coinsurance up to $150||25% coinsurance up to $225|
Calendar year out-of-pocket ("OOP") limit for presciptions is $4,600 individual and $9,200 family. Prescription drug copayments/coinsurance are subject to the OOP limit. Once the member and/or family OOP limit is satisfied, no additional copayments/coinsurance are required for the remainder of the calendar year.
Note, certain medications identified under Health Care Reform will be covered 100%; no cost to the member.
For more information, contact Express Scripts Member Services 24/7 at 1-800-595-0817.