Generic
Preferred brand
Non-preferred brand
Specialty
|
No Charge After Generic Rx Deductible
$40 Copay After Medical Deductible
$70 Copay After Medical Deductible
$300 Copay After Medical Deductible
|
No Charge After Generic Rx Deductible
$80 Copay After Medical Deductible
$140 Copay After Medical Deductible
Not Available
|