JHU SHP Plan — 2021-2022
Prescription Services and Supplies
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In-Network Retail Pharmacy (30-day supply) | In-Network Retail Pharmacy (90-day supply) | Mail Order (90-day supply) | |
---|---|---|---|
Oral Contraceptives | |||
Generic | $0 | $0 | $0 |
Preferred Brand | $25 | $75 | $50 |
Non-Preferred Brand | $40 | $120 | $80 |
Prescription Drugs | |||
Generic | $15 | $45 | $30 |
Preferred Brand | $25 | $75 | $50 |
Non-Preferred Brand | $40 | $120 | $80 |
Revised
September 9, 2022
Group Number
E00016