Comparing Prescription Drug Coverage
Sidebar
You Pay | |||
|---|---|---|---|
PPO with HRA | ULH | CDHP with HSA | |
ANNUAL PRESCRIPTION DEDUCTIBLE FOR IN-NETWORK PHARMACY (not available for out-of-network) | |||
| Per Person | $0 | $0 | Combined with medical deductible of $2,000 |
| Per Family | $0 | $0 | Combined with medical deductible of $4,000 |
| ANNUAL PRESCRIPTION OUT-OF-POCKET MAXIMUM (OOPM) FOR IN-NETWORK PHARMACY (not available for out-of-network) | |||
Per Person |
$4,600 |
$2,600 | Combined with medical OOPM of $4,600 |
Per Family |
$9,200 |
$5,200 | Combined with medical OOPM of $9,200 |
| Non-Specialty Drugs | |||
Generic |
$10 / $201 by mail 25% (max: $60) at retail / 15% (max: $120) by mail 40% (max; $100) / 35% (max: $200) by mail
Plan pays the cost of the generic drug. You pay the remainder of the cost, with no maximum.
25% (max: $100) 25% (max:$150) 40% (max:$250) | $10 after deductible / $201 after deductible by mail | |
Brand Formulary |
25% (max: $60) after deductible / 15% (max: $120) after deductible by mail | ||
Non-Formulary | 40% (max: $100)after deductible / 35% (max: $200) after deductible by mail | ||
| Brand name drug when a generic is available | After you meet the deductible, plan pays the cost of the generic drug. You pay the remainder of the cost with no maximum. | ||
| Specialty Drugs | |||
| Generic | 25%(max: $100) after deductible | ||
| Brand Formulary | 25%(max: $150) after deductible | ||
| Non-Formulary | 40% (max: $250) after deductible | ||
1 Mail order generic medications will be $20, but there are select generic maintenance drugs that will be a $0 copay through mail order. For more information, please contact KY Rx Coalition at 855-218-KYRx or online at kyrx.org.