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Prescription Drug Coverage
Generic
Formulary
Non-Formulary
Specialty
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0%*
0%*
0%*
90%*
Covered Persons using Specialty Drugs included on the Select Drugs and Product List must enroll in the Plan Select Drugs and Products Program. Contact the Specialty Contact Center for additional information at 877-305-6202. Failure to meet prior authorization criteria, including enrollment in the Select Drugs and Products Program when applicable, will result in a cost containment penalty equal to a 100% reduction in benefits payable.
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