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Prescription Drugs
Prescription drug coverage provides a benefit that is important to your overall health, whether you need a
prescription for a short-term health issue like bronchitis or an ongoing condition like high blood pressure.
Aetna Medical
HMO Plan
Kaiser HMO
Medical Plan
Aetna Medical PPO Plan
In-Network
In-Network
In-Network
Out-Of-Network
Prescription Drug
Deductible
N/A
N/A
N/A
N/A
Annual Out-of-
Pocket Limit
Prescriptions
subject to medical
out-of-pocket
maximum
Prescriptions
subject to medical
out-of-pocket
maximum
Prescriptions
subject to medical
out-of-pocket
maximum
N/A
Pharmacy
Generic
$10 copay then
plan pays 100%
$10 copay then
plan pays 100%
$10 copay then
plan pays 100%
Not covered
Preferred Brand
$30 copay then
plan pays 100%
$25 copay then
plan pays 100%
$40 copay then
plan pays 100%
Not covered
Non-preferred Brand
$50 copay then
plan pays 100%
$25 copay then
plan pays 100%
$60 copay then
plan pays 100%
Not covered
Supply Limit
30 days
30 days
30 days
N/A
Mail Order
Generic
$20 copay then
plan pays 100%
$20 copay then
plan pays 100%
$20 copay then
plan pays 100%
Not covered
Preferred Brand
$60 copay then
plan pays 100%
$50 copay then
plan pays 100%
$80 copay then
plan pays 100%
Not covered
Non-preferred Brand
$100 copay then
plan pays 100%
$50 copay then
plan pays 100%
$120 copay then
plan pays 100%
Not covered
Supply Limit
90 days
100 days
90 days
N/A