Page 17 - MPCU Open Enrollment Presentation
P. 17

Medical – Prescriptions













                                                                                                    Cigna

                                                                                     Select and Full HMO



                                                                                         Participating Pharmacy


                        Generic                                                                       $15



                        30 day supply


                        Brand Name                                                                    $35



                        30 day supply


                        Non Formulary                                                                 $50


                        30 day supply



                        Mail Order                                                        $30 / $70 / $100


                        90 day supply
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