4 stars
3 stars
3.5 stars
4.5 stars
Two copayments for 90 day supply at Walmart and Sam’s (preferred pharmacy)
Three copayments for 90 day supply at any other contracted pharmacies
All the above
True
False
Tier 1 = $6; Tier 2 = $20; Tier 3 = $40; Tier 4 = 33%; Tier 5 = 30%
Tier 1 = $6; Tier 2 = $30; Tier 3 = $72; Tier 4 = 33%
Brand Deductible: $220; Tier 1 = $0 at Walmart/$10 others; Tier 2 = $33; Tier 3 = $45; Tier 4 = $95; Tier 5 = 27%
Tier 1 = $6; Tier 2 = $36; Tier 3 = $76; Tier 4 = 20%
True
False
$0
$100
$50
10%
True
False
True
False
%51
%107
$75.90
$120
$1,500
$2,600
$4,500
$5,050
True
False
$10
$15
$20
$30
$250 per admission
$500 per admission
$175 a day for days 1-7
$100 a day for each day in hospital
True
False
True
False