|
Prescription Drug Coverage
Generic
Preferred brand
Non-preferred brand
Specialty
|
$10 Copay After Deductible
$40 Copay After Deductible
$80 Copay After Deductible
25% Coinsurance up to $300*
|
$20 Copay After Deductible
$80 Copay After Deductible
$160 Copay After Deductible
Not Available
|