The maximum a Covered Person will be required to pay per prescription is the actual cost of the prescription up to $6.00 for GENERIC BRAND DRUGS, or $40.00 for PREFFERED NAME BRAND DRUGS, or $70 for single source NON-PREFERRED BRAND NAME DRUGS, or the difference between the Plan cost of a generic and a NON-PREFERRED BRAND NAME DRUGS when both are available.

MAXIMUM PRICE PER DRUG CLASS Generic Brand Drugs Preferred Brand Name Drugs Non-Preferred Brand Name Drugs $6.00 $40.00 $70.00

You are invited to visit the Walgreens.com web site to find a nearby location, access online pharmacy information or use the reference information provided in their health library: