* Formulary = 20% Copay, Non-Formulary = 100% Copay, If you elect a brand item at the pharmacy when there is a generic equivalent available, you may be charged the difference between the brand and generic in addition to your copay amount.

* Drug prices are based on a 90 day supply/quantity for mail order.

* These costs are estimated based on highest drug price per category.

* If your drug has a generic form available the generic name is listed immediately after the brand name.  To access pricing please type in the generic name of your drug search for pricing this way