2026-2027 Benefits Guide

PRESCRIPTION DRUG COVERAGE

Cigna OAP

Cigna HDHP

OUT-OF- NETWORK

IN-NETWORK

IN-NETWORK

OUT-OF-NETWORK

Retail Prescription (retail, 30 day supplies) Deductible does not apply Generic drugs (Tier 1) $20 copay 50% coinsurance

100% after cal yr deductible

Preferred brand drugs (Tier 2)

$50 copay

50% coinsurance

100% after cal yr deductible

Non-preferred brand drugs (Tier 3)

In-network Federally required preventive drugs will be provided at no charge.

$100 copay

50% coinsurance

Specialty drugs (Tier 4)

$150 copay

50% coinsurance

Mail Service Prescription (copays per 90-day supply) Deductible does not apply

$60 copay

Generic drugs (Tier 1) Preferred brand drugs (Tier 2)

$150 copay

100% after cal yr deductible

100% after cal yr deductible

50% coinsurance

Non-preferred brand drugs (Tier 3) Specialty drugs (Tier 4)

$300 copay

N/A More information about prescription drug coverage is available at https://www.cigna.com/individuals families/member-guide/offered-by-employers-drug-list

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