Back to Health Plan Comparison Chart & other information

Prescriptions Drug Benefits for Plan A and Plan B
Tier	Type of Notification	You Pay	Your Coinsurance Maximum
Tier 1	Generic Drugs	20% Coinsurance	There is a combined Coinsurance maximum of $2,580 per person/year that applies to Tiers 1, 2 and 3.
Tier 2	Preferred brand name drugs	35% Coinsurance
Tier 3	Special Case medications (Very high-cost medications used to treat conditions that are generally life threatening)	$75 Copayment per standard fill or 30-day supply
Tier 4	Non preferred brand name drugs	60% Coinsurance	N/A (unless an override has been granted by Caremark)
Tier 5	Discount Tier medications	100% of discounted price	N/A

Preferred drug list, specialty drug list and discount tier list available on the web at www2.caremark.com/kse