2024 Johns Hopkins EPO Plan
Prescription Services and Supplies
Sorry, no results.
| 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 | 25%; $40 min; $60 max | 25%; $120 min; $180 max | 25%; $120 min; $180 max |
| Non-Preferred | 50%; $65 min; $105 max | 50%; $195 min; $315 max | 50%; $195 min; $315 max |
| Prescription Drugs | |||
| Generic | $10 | $30 | $30 |
| Preferred | 25%; $40 min; $60 max | 25%; $120 min; $180 max | 25%; $120 min; $180 max |
| Non-Preferred | 50%; $65 min; $105 max | 50%; $195 min; $315 max | 50%; $195 min; $315 max |
| Brand with Generic Equivalent | 50%; $65 min; $105 max, plus the cost differential between generic and brand | 50%; $195 min; $315 max, plus the cost differential between generic and brand | 50%; $195 min; $315 max, plus the cost differential between generic and brand |
| Specialty Medications for members enrolled in Prudent RX – medications listed at ehp.org | $0 | Restricted to a 30-day retail supply only | Restricted to a 30-day retail supply only |
| Specialty Medications for members not enrolled in Prudent RX – medications listed at ehp.org | 30% | Restricted to a 30-day retail supply only | Restricted to a 30-day retail supply only |
Revised
October 9, 2024
Plan Codes
JE1C0000
