Prescriptions Effective: January 1, 2027 PRESCRIPTION COVERAGE | Plan 1 | Plan 2 | Plan 3 | | COPAYS | P8J6ADT | G746ADT | S731ADT | | PPO $1,100 Plan | PPO $2,100 Plan | PPO $6,850 Plan | | Generic | $10 / $20 | $5 / $10 | $10 / $20 | | Preferred Brand | $50 | $50 | $50 | | Non-Preferred Brand | $100 | $100 | $100 | Specialty $250 / $350 $250 / $350 $250 / $350 The picture can't be displayed. 90 Day Supply Depending on your medication, you might also be eligible for a 90-day supply delivered directly to your home, a convenient option for maintenance prescriptions. To check availability and get started, visit your health plan’s member portal or pharmacy benefits section online. The picture can't be displayed. Ways to Save  Ask your doctor about generic alternatives  Use mail-order or 90-day supply options for maintenance medications, if available  Check for discount programs or manufacturer coupons  Review your plan’s formulary list to see which medications are covered at the lowest cost Coverage Rules to Know Some prescriptions may require extra steps before they’re approved: • Prior Authorization: You may need approval before the plan will cover certain medications. • Step Therapy: You might be required to try lower-cost alternatives before moving to higher-cost medications. • Formulary Exclusions: Not all medications are covered. You can review the plan’s drug list or speak with customer service for details.