Feb 28, 2012 . Prescription: $8 generic; $30 formulary brand; $45 non- formulary brand for retail

Retail, BlueCross BlueShield, BlueChoice. Maintenance, Up to 90-day supply,

$4700 per participant. Generic or Formulary Brand - $0 copay. Non-formulary

A formulary is a list of generic and name-brand prescription medications that a

Prescription Drugs. Retail. Generic: $15. Formulary Brand Name: $25. Non-

Formulary. Brand Non. Formulary. Retail Pharmacy Copayment. (per Prescription

The copays for a participating retail pharmacy (30 day supply) are as follows:

Jan 1, 2012 . In House 30 Day Supply Retail. Benefit. • Generic: 100% after $7 copay. •

No Calendar-Year Brand-Name Drug Deductible. $10 Generic/$20 Formulary

Retail - Maintenance Drugs after 2 fills (up to 30 day supply): generic $30 copay,

A drug formulary is a list of generic and brand name drugs that are preferred by

Retail. You can receive up to a 30 day supply at a retail pharmacyusing your

Up to 31-day supply (avai|a1;|e Preferred F0rmulary_Brand $30.00 through retail

May 10, 2010 . After the annual prescription deductible has been applied, the prescription

$25 FORMULARY BRAND NAME DRUGS. $40 NON-FORMULARY BRAND

This stepped copay applies to both mail service and retail purchases of generic,

$5 retail pharmacy copay for generic medications (30 to 34-day supply) $25 retail

$150 Contract-Year Brand-Name Drug Deductible. $10 Formulary Generic/$30

Sep 28, 2011 . Formulary Brand – Maintenance Drug at Retail After Second Fill. Non-specialty

$15 copay for up to a 30-day supply purchased at a participating retail pharmacy.

A brand-name drug is a medication that has been approved by the FDA for sale

$0 Calendar-Year Brand-Name Drug Deductible. $10 Formulary Generic/$20

This stepped copay applies to both mail service and retail purchases of generic,

through retail and specialty pharmacy). Traditional drugs limited to retail

Retail copayments for formulary brand-name and non-formulary brand-name

Non-Formulary Brand). Retail. Copayments are for up to a 34-day supply at a

Formulary brand 20%. Non-formulary brand 30%. Minimum $40 retail, $80 mail.

Payment Options. (Generic / Formulary Brand / Non-Formulary Brand). Retail.

combined; however, each person will never pay more than the individual

$15 Formulary Generic/$30 Formulary Brand-Name - Retail Pharmacy. $30

Jan 1, 2011 . prescription). PPO/CDHP Retail (30-day supply): No change. PPO/CDHP Mail

Jan 1, 2012 . Retail generic. $7 copay; 30 day supply; formulary generic at participating

Retail: Preferred Brand-Name Drugs/Tier 2 Drugs. Up to a 30-day supply you pay

Retail (up to 30 days supply). Type of Medication Co-pay. Generic 20% (

Retail Drugs (31/60/90-day Supply). $8/$16/$24 generic copayment. $35/$70/

A "non formulary brand name" is a brand name drug that is not in the formulary

Example 1 Retail Pharmacy (30 to 34-day supply): $10 retail pharmacy copay for

A "non formulary brand name" is a brand name drug that is not in the formulary .

Retail (30-day supply) Generic $10. Brand Formulary $20. Brand Non-formulary

The $8 should be the cost for a generic and $15 would be name brand.Any

Retail: up to a 30-day supply, Retail: $7 copay. Mail: up to a 90-day supply, Mail:

(Generic / Formulary Brand / Non-Formulary Brand). Retail. Prescriptions are for

provides a list of formulary brand name medications to help you and your .

New Retail Pharmacy/Mail in Pharmacy Prices as of 1 Octobr 2011. Mail (90 Day

Home. About Us. Members. Employers. Brokers. Providers . www.concerthealth.com/Site/PharmacyPlans.aspx - Cached - SimilarPlan Year 7/1/1290% covered; 30 day supply. Retail formulary brand. 80% covered; 30 day

Retail. Retail Generic. $10 copay. Retail formulary brand. 60% covered; $25

Non-Formulary Brand: $55. Mail Order (90-day supply): (Mandatory mail copay

Retail: 35% coinsurance with $35.00 max for generic drugs; Retail: 35%

Retail: $10; Mail Order: $20. Formulary Brand. Retail: $20; Mail Order: $40. If

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