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Mail Service Preferred and Non-Preferred Brand Name Drugs
Not available $60 for up to 100-day supply
Prescription Drug Coverage Preferred and Non-Preferred Brand Name Drugs
$15 copay for 100-day supply $30 copay for up to […]
Mail Service Preferred and Non-Preferred Brand Drugs
$60 copay for up to 100-day mail order supply
Participating Retail Pharmacy Preferred and Non-Preferred Brand Drugs
$30 copay for up to 30-day retail supply