Deductible  This plan does not have adeductible. 
Pharmacy cost-sharing 
For generic drugs (including  30-day supply 90-day supply 
brand drugs treated as generic), 
either: $0 copay; or  
$1.35 copay; or  
$3.95 copay ;or 
15% of the cost $0 copay; or  
$1.35 copay; or  
$3.95 copay ;or 
15% of the cost 
For all other drugs, either: $0 copay; or  
$4 copay; or  
$9.85 copay ;or 
15%  of the cost  $0 copay; or  
$4 copay; or  
$9.85 copay ;or 
15% of the cost  
ADDITIONAL DRUG COVERAGE 
Erectile dysfunction (ED)