Prescription Drug Plan and List of Pharmacies

Drug Type	Retail Pharmacy	Mail Pharmacy
CURRENT PRESCRIPTION DRUG PLAN
For each prescription filled for you, or a covered dependent, your copayment is:
Generic	30% of the cost of the medication	30% of the cost of the medication
Brand	30% of the cost of the medication	30% of the cost of the medication
Note: The co-pay amounts for all prescription medications increases to 50% when the prescription is filled with a brand name drug and a generic equivalent drug is available and substitutable, as determined by the physican.

MEDTRAK SERVICES PREFERRED NETWORK*
Click above link for a list of participating pharmacies.

*You need Microsoft Word to view and print documents.