/ Human Resources

Prescription Plans At a Glance

2024/25 in-network plans

  Blue (Traditional) Plan Orange (HDHP) Plan
Deductible Not applicable. Pharmacy costs combine with medical plan deductibles.
Maximum out of pocket Pharmacy co-pays combine with medical plan limits Pharmacy co-pays combine with medical plan limits
preventive drug per aca guidelines $0 copay $0 copay
for short term medications (up to a 30 day supply)
in-network retail pharmacy network Not subject to deductible.

$10 generic copay
$40 preferred brand copay
$80 non-preferred brand copay
30% coinsurance (with optional $0 co-pay if enrolled in the Prudent Rx Co-Pay Program), specialty drugs

After deductible.

$10 generic copay
$40 preferred brand copay
$80 non-preferred brand copay
30% coinsurance (with optional $0 co-pay if enrolled in the Prudent Rx Co-Pay Program), specialty drugs
for long term maintenance medications (up to a 90 DAY SUPPLY)
CVS or Target retail pharmacy or CVS/Caremark mail service pharmacy Not subject to deductible.

$20 generic copay
$80 preferred brand copay
$160 non-preferred brand copay
Specialty drugs not eligible, due to maximum 30-day supply limit.

After deductible.

$20 generic copay
$80 preferred brand copay
$160 non-preferred brand copay
Specialty drugs not eligible, due to maximum 30-day supply limit.
All other in-network retail pharmacies Not eligible in plan; expense will be 100% employee cost Not eligible in plan; expense will be 100% employee cost
Benefits at a glance Blue RX BAAG Orange RX BAAG

PROVIDER INFORMATION

1.888.321.4206

 

1.800.578.4403

 

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