PLAN

When it comes to filling your prescriptions, choice, convenience and cost are important to you. There are over 68,000 in your network. They include local pharmacies, grocery stores, retail chains and wholesale warehouse stores — all places where you may already shop. Free Medications Preventive Generic Medications: Preventive No Cost Smoking Cessation and Contraceptive medications are used to prevent conditions like high Medications: The City’s pharmacy plan covers blood pressure, high cholesterol, heart attack, stroke, prescription and over-the-counter smoking cessation diabetes, asthma, prenatal nutrient deficiency, etc. and contraceptive products with no copay, coinsurance The City’s prescription drug plan covers most of these or deductible. medications at no cost to you. Go to Patient Assurance Program: myCigna.com website, app or call Express Scripts at Certain preferred 800-835-3784 to learn which medications are free. brand insulin drugs are eligible for a maximum You can also use the Drug Cost tool to estimate costs copayment of $25 for a 30-day supply and $75 for a of any medications that are not on the no cost list. 90-day supply at participating in-network pharmacies.

Pharmacy Plan Features Comparison Consumer-Driven Health Plan Limited Network Pharmacy plan features Open Access Plan In Network Out-of-Network Plan

Yes. Combined medical and pharmacy $150 individual / $450 Prescription deductible deductible, except for certain preventive No family medications which are not subject to deductible. Retail Generic $10 or cost $10 or cost 20% 20% ($45 min/$100 Retail Preferred Plan pays 80% after $45 60% max) the deductible is met Plan pays 40% after 40% ($55 min/$150 Retail Non-preferred the deductible is met $60 Specialty medications max) are 30-day supply only 40% ($100 min/$300 Retail Specialty $100 max) Free mail-order Generic and preferred brand diabetes, asthma, blood pressure, osteoporosis, prenatal vitamins, prescriptions through Cigna cholesterol, anxiety, depression, and bipolar related drugs and supplies. Home Delivery Pharmacy

Participating Pharmacies: 30-day Participating Pharmacies: 90-day

• CVS/ Target • CVS/ Target • • Kroger • H-E-B Pharmacy • • Kelsey-Seybold • • Walmart Visit Cigna.com/Rx90network to see a complete list of pharmacies in your network.

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