Pharmacy Benefits Summary
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Standard Option Rx Benefits for 2010
† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.
*50% of the Plan's allowance and any difference between our allowance and the billed amount.
| Topic | You Pay | ||||
|---|---|---|---|---|---|
| Topic | Generic—Network Provider | Preferred Brands—Network Provider | Non-Preferred Brands—Network Provider | Specialty Drugs †--Network Provider | All Covered Rx—Non-Network and Paper Claims |
| Up to 30-day supply from a network pharmacy | $10 copay | $40 copay | $60 copay | $100 copay | *50% |
| Up to 90-day supply through mail order | $15 copay | $65 copay | $90 copay | $300 copay | Not Covered |
Value Plan Rx Benefits for 2010
| Topic | You Pay | ||
|---|---|---|---|
| Topic | Generic—Network Provider | Non-Generic—Network Provider | All Covered Rx—Non-Network Provider and Paper Claims |
| Up to 30-day supply from a network pharmacy | $10 copay | 50% of the Plan's allowance | Not Covered |
| Up to 90-day supply through mail order | $30 copay | 50% of the Plan's allowance | Not Covered |
Consumer Option Rx Benefits for 2010
** $2,000 per person/$4,000 per family combined medical and Rx deductible
| Topic | You Pay | |||
|---|---|---|---|---|
| Topic | Generic—Network Provider | Preferred Brands—Network Provider | Non-Preferred Brands—Network Provider | Non-Network Provider and Paper Claims |
| Annual Deductible | Annual Deductible** | Annual Deductible** | Annual Deductible** | Annual Deductible** |
| Up to 30-day supply from a network pharmacy | $10 copay | $25 copay | $40 copay | Not Covered |
| Up to 90-day supply through mail order | $20 copay | $50 copay | $80 copay | Not Covered |
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