Health & Welfare Medical
Prescriptions

Prescriptions

Express Scripts
(Independence Active and Bronze Participants)

Type of Drug Retail Network Pharmacy
(Up to a 30-Day Supply)
Mail Order Home Delivery or Smart 90
Generic $10; $0 for prescription contraceptives $25; $0 for prescription contraceptives
Preferred Brand $40 $100
Non-preferred Brand $60 $150
Specialty $50 $100
Preferred/Non-Preferred Brand For Which There is a Generic Equivalent Available You will be charged the brand copayment, plus the difference in cost between the brand and the generic You will be charged the brand copayment, plus the difference in cost between the brand and the generic

Routine maintenance medications are covered for a 30-day supply for only 2 fills. After the 2nd fill, you will pay the retail price for the medication unless you use the mail order pharmacy or visit a CVS Pharmacy for the Smart90 program to purchase a 90-day supply.

Express Scripts can help you arrange for at home delivery or locate a pharmacy.

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Kaiser
(Only in California, Colorado, Washington and Oregon, Bronze Plan Excluded)

Type of Drug Retail Network Pharmacy
(Up to a 30-day Supply)
Mail Order Pharmacy
<sub">(CA: 100-Day Supply; CO: 90-day Supply)
Generic $10; $0 for prescription contraceptives $20; $0 for prescription contraceptives
Preferred Brand $30 $60
Specialty 20% Coinsurance
(not to exceed $250 per 30-day supply)
Contact Kaiser
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