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If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

2012 Secure Blue PPO Out-of-Network Prescription Drug Cost Sharing

Your initial share of the cost when you get a 30-day supply (or less) of a
covered Part D prescription drug from an out-of-network pharmacy:

Cost-Sharing
Tier 1

Generics

$10 Copayment

Difference between in-network and out-of-network costs may apply.

Cost-Sharing
Tier 2

Preferred Brand

$45 Copayment

Difference between in-network and out-of-network costs may apply.

Cost-Sharing
Tier 3

Non-Preferred Brand

$95 Copayment

Difference between in-network and out-of-network costs may apply.

Cost-Sharing
Tier 4

Specialty Drugs

33% Coinsurance

Difference between in-network and out-of-network costs may apply.

(Coverage is limited to certain situations; see Evidence of Coverage for details.)

Y0010_MK 12155 CMS Approval 11/9/2011