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| Oregon & Washington |
Saver |
Preferred |
Enhanced |
| Mo Premium |
$26.70 |
$38.40 |
$79.10 |
| Deductible |
$295 |
$0 |
$0 |
| Tier 1 (generics) |
$5 copay |
$5 copay |
$7 copay |
| Tier 2 (Non-preferred generic) |
$22 copay |
$38 copay |
$39 copay |
| Tier 3 (preferred brand) |
$61.10 copay |
$81.20 copay |
$95.00 copay |
| Tier 4 (Specialty) |
25% |
33% |
33% |
| Coverage Gap** |
None |
None |
Yes |
| Tier 1 (generics) |
n/a |
$10 copay |
$14 copay |
| Tier 2 (Non-preferred generic) |
n/a |
$25 copay |
n/a |
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| Catastrophic Coverage |
$2.40 copay |
$2.40 copay |
$2.40 copay |
| after yearly costs reach $4,350 |
$6 copay or 5% |
$6 copay or 5% |
$6 copay or 5% |
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| Mail Order (90 day supplies***) |
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| Tier 1 (generics) |
$0 copay |
$0 copay |
$0 copay |
| Tier 2 (Non-preferred generic) |
$15 copay |
$21 copay |
$21 copay |
| Tier 3 (preferred brand) |
168.30 copay |
$228.60 copay |
$270.00 copay |
| Tier 4 (Specialty) |
25% |
30% |
30% |
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| ** after yearly drug costs reach $2,700 you pay 100%, unless otherwise noted |
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| ***applies to preferred mail order pharmacy |
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