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Prescription Drugs, continued
Here are the prescription drug plans that are offered with our Aetna PPO plan.
Aetna PPO
In-Network
Out-Of-Network
Prescription Drug Deductible
None
None
Annual Out-of-Pocket Limit
$2,500
$5,000
$5,000
$10,000
Pharmacy
Generic
$15 copay
Not Covered
Preferred Brand
$25 copay
Not covered
Non-preferred Brand
$40 copay
Not covered
Supply Limit
30 days
Not applicable
Mail Order
Generic
$30 copay
Not covered
Preferred Brand
$50 copay
Not covered
Non-preferred Brand
$80 copay
Not covered
Supply Limit
90 days
Not applicable