Prescription Medications ($0 deductible)

Initial Coverage

• You pay $0 copayment:
• or $1.10 copayment;
• or $3.30 copayment
• until total yearly drug costs (paid by member and the plan) reach $2,830.

Coverage Gap

• After total yearly drug costs (paid by member and the plan) reach $2,830, you pay $0 for your drugs.

Catastrophic Coverage

• After your yearly out-of-pocket drug costs reach $4,550, you pay $0 for the rest of the year.