Prescription Drugs (Express Scripts)
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Prescription Drugs (Express Scripts)
Prescription Drugs (Express Scripts) Prescription drug coverage provides a benefit that is important to your overall health, whether you need a prescription for a short-term health issue like bronchitis or an ongoing condition like high blood pressure. Delta Health Systems (Anthem Blue Cross Network) Medical PPO Plan A Delta Health Systems (Anthem Blue Cross Network) Medical PPO Plan B In-Network Out-Of-Network In-Network Out-Of-Network $4,600 Individual $7,200 Family $4,600 Individual $7,200 Family $3,350 Individual $6,700 Family $3,350 Individual $6,700 Family Generic $5 copay $5 copay $10 copay $10 copay Preferred Brand Plan pays 50% to $30 copay maximum per prescription Plan pays 50% to $30 copay maximum per prescription Plan pays 50% to $40 copay maximum per prescription Plan pays 50% to $40 copay maximum per prescription Non-preferred Brand Plan pays 50% to $80 copay maximum per prescription Plan pays 50% to $80 copay maximum per prescription Plan pays 50% to $100 copay maximum per prescription Plan pays 50% to $100 copay maximum per prescription Supply Limit 30 days 30 days 30 days 30 days Generic $10 copay Not covered $20 copay Not covered Preferred Brand Plan pays 50% to $60 copay maximum per prescription Not covered Plan pays 50% to $80 copay maximum per prescription Not covered Non-preferred Brand Plan pays 50% to $160 copay maximum per prescription Not covered Plan pays 50% to $200 copay maximum per prescription Not covered Supply Limit 90 days Not applicable 90 days Not applicable Annual Out-of-Pocket Limit Pharmacy Mail Order 12