Aetna Standard Formulary

Aetna will provide health and prescription coverage for faculty, staff, and retirees of Truman State University for the 2019 plan year (January 1 through December 31, 2019).

Prescription Drug Co-Pays for Plan A and Plan B are as follows:

	Retail (30-day supply)*	Mail-Order (90-day supply)*
Level 1 (Generics)	$15	$30
Level 2 (Formulary Brand name)	$30	$60
Level 3 (Non-Formulary Brand name)	$60	$120
Level 4 (Self-Injectibles)	20% ($200 max per prescription)	20% ($200 max)

 

Prescription Drug Co-Pays for Plan C are as follows:

The full cost of the drug is applied to the deductible before benefits are considered for payment under the pharmacy plan except for the preventative medications listed here.

	Retail (30-day supply)*	Mail-Order (90-day supply)*
Level 1 (Generics)	20%	20%
Level 2 (Formulary Brand name)	20%	20%
Level 3 (Non-Formulary Brand name)	20%	20%
Level 4 (Self-Injectible)	20%	20%

*Coverage is in-network only.  Please refer to Benefit Summaries for out of network premiums.