You need to treat your Generic drugs (no brand name) [Plans should insert a There may be limitations on the types of drugs illness or condition single amount or all covered. Please see <plan name>’s List of applicable copay Covered Drugs (Drug List) for more information. amounts for a tier with [Plans must indicate if extended-day supplies LIS copay amounts] for are available at retail and/or mail order a [must be at least pharmacy locations and make clear that the supply. cost sharing amount for these extended-day [Plans may delete the supplies is the same as for a one-month following statement if supply.] they charge $0 for all generic drugs.] Copays for prescription drugs may vary based on the level of Extra Help you get. Please contact the plan for more details.
You need to treat your illness or condition Generic drugs (no brand name) [Plans should insert a single amount or all applicable copay amounts for a tier with LIS copay amounts] for a [must be at least supply. [Plans may delete the following statement if they charge $0 for all generic drugs.] Copays for prescription drugs may vary based on the level of Extra Help you get. Please contact the plan for more details. There may be limitations on the types of drugs covered. Please see <plan name>’s List of Covered Drugs (Drug List) for more information. [Plans must indicate if extended-day supplies are available at retail and/or mail order pharmacy locations and make clear that the cost sharing amount for these extended-day supplies is the same as for a one-month supply.]
OHSB2018.docx