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Benefits

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Benefits

Please call Pharmacy Customer Service if you have any questions about your prescription drug benefits: 254-298-6100 or 1-800-728-7947.

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Prescription Drugs and Diabetic Supplies

Up to a 34-Day Supply Basic Enhanced
Preferred Generic $10 copay $10 copay
Preferred Brand* $30 copay $30 copay
Non-Preferred Generics & Brands* $60 copay $60 copay
Up to a 100-Day Supply Basic Enhanced
Preferred Generic $20 copay $20 copay
Preferred Brand* $60 copay $60 copay
Non-Preferred Generics & Brands* $120 copay $120 copay

* Dispense as Written: generic copay plus the difference between the cost of the brand and generic drug

Specialty Drugs Dispensed by the Pharmacy (up to 34 day supply)
Preferred Drugs (Level 1-3) 10% no maximum
Non-Preferred (Level 4)
(Level 4 Copayment does not count toward Out-of-Pocket Maximum)
10% no maximum