Page 13 - Open Enrollment Guide Sample

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Mandatory Generic Drug Policy

Our plan requires you to use a generic drug when one is available. A
generic drug has the same chemical components as a brand name drug;
therefore, generic drugs are the most cost-effective prescription treatment.
If there is no generic available, you will pay the brand name copay listed
on the next page. If you choose a brand name drug when a generic exists,
you will pay the generic copay plus the cost difference between the brand
name and generic drug. For example, if you chose to purchase CIPRO (a
preferred brand name drug) instead of the available generic, the following
example would apply:

Cost of CIPRO $100
Cost of Generic -$25
Difference in Cost $75
Mandatory Generic Copay +$10
Your Total Cost $85
* For illustrative purposes only—does not represent actual cost

Pharmacy Network

[Client] partners with the Express Advantage Network. Remember,
CVS and Walgreens are not in-network. Members can still use CVS
and Walgreens but will have to pay the full discounted cost of the

prescriptions. In-network providers include Walmart, Kroger, Target,
Kmart, Costco, and many local grocery store pharmacies. To search
for additional in-network providers visit www.expressscripts.com
after January 1, 2015, or you can call the number on the back of your
medical ID card. Refer to page 14 for the cost of retail and mail order
prescriptions.

2016 Open Enrollment