Copayments and annual out-of-pocket maximums. For the first and second year of the contract:
Copayments and annual out-of-pocket maximums. For the first and second year of the contract: Tier 1 copayment: Eighteen dollar ($18) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply.
Copayments and annual out-of-pocket maximums. 4 For each the first year of the contract: 6 Tier 1 copayment: Ten dollar ($10) copayment per prescription or refill for a Tier 7 1 drug dispensed in a thirty (30) day supply. 9 Tier 2 copayment: Sixteen dollar ($16) copayment per prescription or refill for a 10 Tier 2 drug dispensed in a thirty (30) day supply. 12 Tier 3 copayment: Thirty-six dollar ($36) copayment per prescription or refill for
13 a Tier 3 drug dispensed in a thirty (30) day supply. 15 Out-of-pocket maximum: There is an annual maximum eligible out-of-pocket 16 expense limit for prescription drugs of eight hundred dollars ($800) per person or 17 one thousand six hundred dollars ($1,600) per family. 19 For the second year of the contract: 21 Tier 1 copayment: Twelve dollar ($12) copayment per prescription or refill for a 22 Tier 1 drug dispensed in a thirty (30) day supply. 24 Tier 2 copayment: Eighteen dollar ($18) copayment per prescription or refill for 25 a Tier 2 drug dispensed in a thirty (30) day supply. 27 Tier 3 copayment: Thirty-eight dollar ($38) copayment per prescription or refill 28 for a Tier 3 drug dispensed in a thirty (30) day supply. 2 Out of pocket maximum: There is an annual maximum eligible out-of-pocket 3 expense limit for prescription drugs of eight hundred dollars ($800) per person or 4 one thousand six hundred dollars ($1,600) per family.
Copayments and annual out-of-pocket maximums. For each year of the contract: Tier 1 copayment: Ten dollar ($10) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty (30) day supply. Tier 2 copayment: Sixteen dollar ($16) copayment Per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 copayment: Thirty-Six dollar ($36) copayment per prescription or refill for a Tier 3 drug dispensed in a thirty (30) day supply. Out-of-pocket maximum: There is an annual maximum eligible out of-pocket expense limit for prescription drugs of eight hundred dollars ($800) per person or one thousand six hundred dollars ($1,600) per family.
Copayments and annual out-of-pocket maximums. For the first and second year of the Contract: Tier 1 co-payment: Twelve dollar ($12.00) copayment per prescription or refill for a Tier 1 drug dispensed in a thirty day (30) supply. Tier 2 co-payment: Eighteen dollar ($18.00) copayment per prescription or refill for a Tier 2 drug dispensed in a thirty (30) day supply. Tier 3 co-payment: Thirty-eight dollar ($38.00) copayment per prescription or refill for a Tier 3 drug dispensed in a thirty (30) day supply. Out-of-pocket maximum: There is an annual maximum eligible out-of-pocket expense limit for prescription drugs of eight hundred dollars ($800.00) per person or one thousand six hundred dollars ($1,600.00) per family.
