Common use of Prescription at Retail Clause in Contracts

Prescription at Retail. The prescription plan is a thirty (30) day supply (or less if so prescribed) for drugs per one co-pay at retail using a three (3) tier “Formulary” structure in which generic and formulary/preferred brand drugs are outlined on the formulary list designed and administered by the Preferred Benefit Manager (PBM). The co-pays are: $5 for generic drugs, $20 for brand drugs that are listed on the formulary (preferred) list with no equivalent generic drug available, and $35 for brand drugs that are not on the formulary (non- formulary/non-preferred) list.

Prescription at Retail. For Officers who retire January 1, 2017 through February 28, 2017: The prescription plan Prescription Plan is a thirty (30) day supply (or less if so prescribed) for drugs per one co-pay at retail using a three (3) tier “Formulary” structure in which generic and formulary/preferred brand drugs are outlined on the formulary list designed and administered by the Preferred Benefit Manager (PBM). The co-pays are: $5 for generic drugs, $20 for brand drugs that are listed on the formulary (preferred) list with no equivalent generic drug available, and $35 for brand drugs that are not on the formulary (non- non-formulary/non-preferred) list.

Prescription at Retail. The prescription plan Prescription Plan is a thirty (30) day supply (or less if so prescribed) for drugs per one co-pay at retail using a three (3) tier “Formulary” structure in which generic and formulary/preferred brand drugs are outlined on the formulary list designed and administered by the Preferred Benefit Manager (PBM). The co-pays are: $5 for generic drugs, $20 for brand drugs that are listed on the formulary (preferred) list with no equivalent generic drug available, and $35 for brand drugs that are not on the formulary (non- formulary/non-preferred) list.

Prescription at Retail. 1. Effective January 1, 2017 through February 28, 2017: The prescription plan Prescription Plan is a thirty (30) day supply (or less if so prescribed) for drugs per one co-pay at retail using a three (3) tier “Formulary” structure in which generic and formulary/preferred brand drugs are outlined on the formulary list designed and administered by the Preferred Benefit Manager (“PBM”). The co-pays are: $5 for generic drugs, $20 for brand drugs that are listed on the formulary (preferred) list with no equivalent generic drug available, and $35 30 for brand drugs that are not on the formulary (non- non-formulary/non-preferred) list.