Prescription Copayments

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.