Pharmacy Benefits |
All UA Choice Plans |
Network Pharmacy: 30-day supply (charges do not apply to medical out-of-pocket maximum) |
$5 copay for generic (Tier 1)
$20 copay for preferred name brand (Tier 2)
$40 copay for non-preferred brand (Tier 3) |
| Home Delivery: 100-day supply (charges do not apply to medical out-of-pocket maximum) |
$10 copay for generic (Tier 1)
$40 copay for preferred name brand (Tier 2)
$70 copay for non-preferred brand (Tier 3) |
Non-Network Pharmacy: (charges do not apply to medical out-of-pocket maximums) |
Pay retail price at time of purchase, submit claim form to be reimbursed at negotiated price less appropriate copayment
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All UAA Choice pharmacy benefits subject to negotiated price limits. |
