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Prescription Drug Deductibles and Copays
- Calendar Year Deductible

$75 / person; $150 / family

$75 / person; $150 / family
- Supply Per Prescription or Refill

Up to 30 days

Up to 90 days

Generic Medication

Best option to help you save money

$10 or 10% (Higher of)

$20 or 10% (Higher of);
max copay is $50/prescription

Preferred Brand-Name Medications

Best option when a generic isn't available

$25 or 25% (Higher of)

$50 or 25% (Higher of);
max copay is $125/prescription

Non-Preferred Brand Name

Highest cost option

$40 or 40% (Higher of)

$100 or 40% (Higher of);
max copay is $300/prescription
  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
  • In addition to the maximum copays listed above, if you receive a brand name drug when a generic exists, you will pay the difference in cost between the generic and brand name medication.

 

  • Generic preventive services medications, including contraceptives, are covered at 100 percent with no deductible or copay.
- Specialty Medications

Enrolled in PrudentRX

$0 Copay 

$0 Copay

Generic (not enrolled in PrudentRX)

30%

30%

Preferred Brand (not enrolled in PrudentRX)

30%

30%

Non-Preferred Brand (not enrolled in PrudentRX)

30%

30%