PPO Choice Prescription Drugs

The following chart describes the different costs associated with the pharmacy you choose based on your Medical Plan.

	PPO Choice Plans
	Retail Pharmacy	PRxN Pharmacy Main Pharmacy Foxwoods Satellite Mail Service
Summary of what you pay:	up to 30-day supply	up to 30-day supply	up to 90-day supply
Generic	$10	$10	$20
Preferred Brand	$40	$40	$100
Non-Preferred Brand	$70	$70	$175

Important Information about your Prescription Drug Coverage

When you enroll for Medical coverage, you also receive prescription drug benefits that use a three-tier classification and pricing structure. It is mandatory for you to fill all prescriptions using generic drugs whenever they are available. If not, you are responsible for the full cost of the Brand Name Prescription. Specialty drugs can only be filled through the PRxN Pharmacy.

Deductibles

For PPO Choice Plans, preferred and non-preferred brand prescriptions are subject to the annual medical deductible. (Generic prescriptions are not subject to deductible). If you haven’t met your deductible, you will be responsible for the cost of your medication. Once your deductible has been met, you will be responsible for a portion of the cost of your medication, as shown in the chart above.

Out-of-Pocket Maximums

The annual out-of-pocket maximum includes deductibles, coinsurance and copays for medical and prescription drugs.