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Prescription Drug Coverage
Generic
Preferred Brand
Non-Preferred Brand
Specialty Drugs
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Retail 30 Day Supply
$15 Copay after Deductible
$35 Copay after Deductible
$60 Copay after Deductible
$15/$35/$60 Copay after Deductible
|
Mail Order 90 Day Supply
$45 Copay after Deductible
$105 Copay after Deductible
$180 Copay after Deductible
Not Available
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