Retail Prescription Purchases

There is no annual deductible for retail prescriptions. Benefits will be paid in accordance with the following reimbursement percentages:

 

	NBN/Rx Network Pharmacy	Non-Network Pharmacy
Generic. . . . . . . . . . . .	100% (of discounted price after $8 copay)	100% (of retail price after $12 copay)
Brand Name Drugs. . . . .	60% (of discounted price)	50% (of retail price)

A maximum 34-day supply is allowed.

When a network pharmacy is used, qualified generic drugs will be substituted when permitted by the prescribing physician. This is one of the most important features of this program given the wide cost difference between generic and brand name drugs. Participants may override this policy if they do not wish to accept a generic drug. Reimbursement in such cases, however, will be based upon the generic price and the brand copay will apply.

Mail Order Prescription Purchases
There is no annual deductible for mail order prescriptions. Benefits will be paid in accordance with the following reimbursement percentages:

 

Generic. . . . . . . . . . . .	100% After $15 Copay Per Prescription
Brand Name Drugs. . . . .	100% After $30 Copay Per Prescription