Pharmacy
Tier 1-$ 5, Tier 2-$10, Tier 3-$25

Tier 1-$ 5, Tier 2-$15, Tier 3-$25

Tier 1-$ 5, Tier 2-$15, Tier 3-$30

Tier 1-$ 6, Tier 2-$16, Tier 3-$31

Tier 1-$10, Tier 2-$15, Tier 3-$30

Tier 1-$10, Tier 2-$15, Tier 3-$35

Tier 1-$10, Tier 2-$20, Tier 3-$35

Tier 1-$10, Tier 2-$20, Tier 3-$40

Tier 1-$10, Tier 2-$25, Tier 3-$45

Tier 1-$10, Tier 2-$30, Tier 3-$45

Tier 1-$15, Tier 2-$25, Tier 3-$40

Tier 1-$5, Tier 2-$10, Tier 3-$25 with $100 individual/$200 family dedcutible

Tier 1-$5, Tier 2-$15, Tier 3-$30 with $100 individual/$200 family dedcutible

Tier 1-$10, Tier 2-$20, Tier 3-$35 with $100 individual/$200 family dedcutible

Tier 1-$10, Tier 2-$30, Tier 3-$45 with $100 individual/$200 family dedcutible

Tier 1-$10, Tier 2-$30, Tier 3-$45 with $250 individual/$500 family deductible