Prescription Drug Copay Tiers and Amounts
Defines retail and mail-order copay amounts by drug tier and explains tier definitions and specialty drug note; applies to Health New England members covered by this plan.
No material clinical or coverage changes in this revision.
Coverage and Payment Structure
Copay tiers and coverage notes
Coverage stance and payment structure for prescription drugs under the plan:
ALL of the following
Retail copay applies as follows
- Generic / Tier 1 — Retail copay: $30
- Brand Formulary / Tier 2 — Retail copay: $80
- Brand Non-Formulary / Tier 3 — Retail copay: $125
- Formulary Specialty / Tier 4 — Retail copay: $150
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