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Co-Payments
The co-payments for each type of retail (30-Day) prescription at your local participating pharmacy (including Express Scripts Mail Service Pharmacies) are:
| Prescription Drug | Retail | Mail/Home Delivery (3 month supply for price of 2 co-payments) |
|---|---|---|
| Generic |
Employee is responsible for paying 10% of the cost with limits of $10 min. and $20 maximum.
|
Employee is responsible for paying 5% of the cost with limits of $20 min. and $40 maximum.
|
| Brand Formulary |
Employee is responsible for paying 20% of the cost with limits of $20 min. and $40 maximum.
|
Employee is responsible for paying 15% of the cost with limits of $40 min. and $80 maximum.
|
| Non-Formulary |
Employee is responsible for paying 40% of the cost with limits of $35 min. and $75 maximum.
|
Employee is responsible for paying 35% of the cost with limits of $70 min. and $150 maximum.
|
last modified
2007-07-23 15:29
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