Prescription Drug Coverage Cost
The plan structure differs depending on which medical plan you select:
PennCare/Personal Choice PPO, Aetna Choice POS II and Keystone/AmeriHealth HMO plans
Aetna High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)
PennCare/Personal Choice PPO, Aetna Choice POS II and Keystone/AmeriHealth HMO plans
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Generics |
Brand Names With No Generic Equivalents |
Brand Names With a Generic Equivalent* |
| Coinsurance; Minimum and Maximum Payment |
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| Non-maintenance |
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| 34-day supply (any network retail pharmacy) |
10%; $5 min/$20 max |
30%; $15 min/$75 max |
10%+; $15 min/$100 max* |
| Maintenance |
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| 34-day supply (any network retail pharmacy, up to 3 fills)** |
10%; $5 min/$20 max |
30%; $15 min/$75 max |
10%+; $15 min/$100 max* |
| 34-day supply (any network retail pharmacy, after 3 fills)** |
20%; $10 min/$40 max |
60%; $30 min/$150 max |
20%+; $30 min/$200 max* |
| 90-day supply (CVS pharmacy or mail order) |
10%; $10 min/$40 max |
20%; $20 min/$100 max |
10%+; $30 min/$200 max* |
| Annual Out-of-Pocket Maximum |
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$2,000 individual/$6,000 family* |
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*For brand names with a generic equivalent, you pay a percentage of the brand name cost PLUS the cost difference between brand name and generic. The cost difference between brand name and generic does not count toward the minimums and maximums.
**After three 34-day fills, you will pay double the normal coinsurance amount as well as double the minimum and maximum coinsurance payments. You can save money by ordering 90-day supplies through the mail order program.
Aetna High Deductible Health Plan (HDHP) with a Health Savings Account (HSA)
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| Annual Deductible* |
$1,500 individual/$3,000 family |
| Annual Out-of-Pocket Maximum* |
$3,000 individual/$6,000 family |
| Preventive Generic Drugs (any retail or mail order, maintenance or non-maintenance) |
10%, no deductible |
| Preventive Brand Name Drugs (with or without generic equivalent, any retail or mail order, maintenance or non-maintenance) |
10% after deductible |
| Non-Preventive Drugs (generic or brand, with or without generic equivalent, any retail or mail order, maintenance or non-maintenance) |
10% after deductible |
| 90-day supply (CVS pharmacy or mail order) |
10% after deductible |
** Amounts you pay toward medical and behavioral health/substance abuse also count toward the deductible and out-of-pocket maximum. After the out-of-pocket maximum is reached, all covered prescription drugs are paid at 100%.