Medical Plan Benefits:
The benefit information above is a PDF file. If you do not have Adobe® Reader®, download it free of charge at Adobe's site.
Prescription Drug Benefits:
If you prefer a brand-name drug that has a generic equivalent, or if you or your provider order a brand-name drug when a generic equivalent is available, you will pay the difference in cost between the generic and brand-name drug, in addition to the generic drug copayment.
| Retail Pharmacy Program (30-day supply or 120 units, whichever is less) | You pay: |
| Generic drug on Drug List | $10 copay |
| Brand-name drug on Drug List | 30% (Minimum $25, Maximum $45) |
| Drug not on Drug List | 40% (Minimum $45, Maximum $80) |
| Specialty Drug | 25% (Minimum $125, Maximum $250) |
| PrimeMail Pharmacy Program/Mail-Order Service (90-day supply or 360 units, whichever is less) | You pay: |
| Generic drug on Drug List | $20 copay |
| Brand-name drug on Drug List | 30% (Minimum $50, Maximum $90) |
| Drug not on Drug List | 40% (Minimum $90, Maximum $160) |
To learn more, see Prescription Drugs.
If you have questions about benefits, please e-mail us or call us toll-free at 1-866-369-NMSU (6678).
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