Employee Prescription Drug Plan Copayments for Plan Year 2018

State Health Benefits Program and School Employees' Health Benefits Program

If you have any questions regarding this information, contact the Office of Client Services at (609) 292-7524 or send an e-mail

State Employees Enrolled in the SHBP

Aetna Freedom15, NJ DIRECT15, Aetna HMO, Horizon HMO


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $3 $10 Member pays difference*
31-60 days $6 $20 Member pays difference*
61-90 days $9 $30 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $5 $15 Member pays difference*

Aetna Liberty Plan, OMNIA Health Plan, Aetna Freedom 1525, NJ DIRECT1525


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $7 $16 Member pays difference*
31-60 days $14 $32 Member pays difference*
61-90 days $21 $48 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $18 $40 Member pays difference*

Aetna Freedom2030, NJ DIRECT2030


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $3 $18 Member pays difference*
31-60 days $6 $36 Member pays difference*
61-90 days $9 $54 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $5 $36 Member pays difference*

Aetna Freedom2035, NJ DIRECT2035


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $7 $21 Member pays difference*
31-60 days $14 $42 Member pays difference*
61-90 days $21 $63 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $18 $52 Member pays difference*

Under the High Deductible Health Plans (HDHP) prescription drug benefits are subject to the HDHP deductible and coinsurance. See your plan guidebook or contact your HDHP directly for details.

*You pay the applicable generic copayment as listed above, plus the cost difference between the brand drug and the generic drug.

Note: In certain circumstances of intolerance or the therapeutic failure of a drug's generic equivalent, a member may be able to receive a third tier brand name drug where a generic equivalent is available for the lower second tier copayment for a brand name drug without generic equivalent.

Local Government Employees Enrolled in the SHBP

Aetna Freedom10, NJ DIRECT10, Aetna Freedom15, NJ DIRECT15, Aetna HMO, Horizon HMO


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $3 $10 $10 Member pays difference*
31-60 days $6 $20 $20 Member pays difference*
61-90 days $9 $30 $30 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $5 $15 $15 Member pays difference*

Local Government Employees Enrolled in the SHBP

Aetna Liberty Plan, OMNIA Health Plan, Aetna Freedom 1525, NJ DIRECT1525


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $7 $16 $35 Member pays difference*
31-60 days $14 $32 $70 Member pays difference*
61-90 days $21 $48 $105 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $18 $40 $88 Member pays difference*

Local Government Employees Enrolled in the SHBP

Aetna Freedom2030, NJ DIRECT2030


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-30 days $3 $18 $46 Member pays difference*
31-60 days $6 $36 $92 Member pays difference*
61-90 days $9 $54 $138 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Brand Name Drug (w/o generic equivalents) Brand Name Drug (w/ generic equivalents)
01-90 days $5 $36 $92 Member pays difference*

Local Government Employees Enrolled in the SHBP

Aetna Freedom2035, NJ DIRECT2035


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand OR Brand Name Drug (w/ generic equivalents)
01-30 days $7 $21 Member pays difference*
31-60 days $14 $42 Member pays difference*
61-90 days $21 $63 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand OR Brand Name Drug (w/ generic equivalents)
01-90 days $18 $52 Member pays difference*

Under the High Deductible Health Plans (HDHP) prescription drug benefits are subject to the HDHP deductible and coinsurance. See your plan guidebook or contact your HDHP directly for details.

*You pay the applicable generic copayment as listed above, plus the cost difference between the brand drug and the generic drug.

Note: In certain circumstances of intolerance or the therapeutic failure of a drug's generic equivalent, a member may be able to receive a third tier brand name drug where a generic equivalent is available for the lower second tier copayment for a brand name drug without generic equivalent.

Local Education Employees Enrolled in the SEHBP

Aetna Freedom10, NJ DIRECT10, Aetna Freedom15, NJ DIRECT15, Aetna HMO, Horizon HMO


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-30 days $3 $10 $10
31-60 days $6 $20 $20
61-90 days $9 $30 $30

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-90 days $5 $15 $15

Local Education Employees Enrolled in the SEHBP

Aetna Freedom 1525, NJ DIRECT1525, Aetna HMO1525, Horizon HMO1525


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-30 days $7 $16 $35
31-60 days $14 $32 $70
61-90 days $21 $48 $105

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-90 days $18 $40 $88

Local Education Employees Enrolled in the SEHBP

Aetna Freedom2030, NJ DIRECT2030, Aetna HMO2030, Horizon HMO2030


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-30 days $3 $18 $46
31-60 days $6 $36 $92
61-90 days $9 $54 $138

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-90 days $5 $36 $92

Local Education Employees Enrolled in the SEHBP

Aetna Freedom2035, NJ DIRECT2035, Aetna HMO2035, Horizon HMO2035


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-30 days $7 $21 Member pays difference*
31-60 days $14 $42 Member pays difference*
61-90 days $21 $63 Member pays difference*

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-90 days $18 $52 Member pays Difference*

Under the High Deductible Health Plans (HDHP) prescription drug benefits are subject to the HDHP deductible and coinsurance. See your plan guidebook or contact your HDHP directly for details.

*You pay the applicable generic copayment as listed above, plus the cost difference between the brand drug and the generic drug.

Note: In certain circumstances of intolerance or the therapeutic failure of a drug's generic equivalent, a member may be able to receive a third tier brand name drug where a generic equivalent is available for the lower second tier copayment for a brand name drug without generic equivalent.

When the local public employer does not provide either the State's Employee Prescription Drug Plan or private prescription drug plan

The NJ DIRECT Prescription Drug Plan, Aetna Freedom Prescription Drug Plan, and HMO Prescription Drug Plan - when the local public employer does not provide either the State's Employee Prescription Drug Plan or private prescription drug plan, the following coinsurance or copayments apply.

Coinsurance is 10% for NJ DIRECT10 and NJ DIRECT15; coinsurance is 15% for NJ DIRECT1525 and NJ DIRECT2030; coinsurance is 20% for NJDIRECT2035.

Copayments for Aetna Freedom10, Aetna Freedom15, Aetna HMO and Horizon HMO


Retail Pharmacy Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-30 days $5 $10 $20
31-60 days $10 $20 $40
61-90 days $15 $30 $60

Mail Order Copayment Amounts - Up to a 90-day Supply

Supply Generic Preferred Brand Name Drug Non-Preferred Brand Name Drug
01-90 days $5 $15 $25

Copayments for Horizon OMNIA, Aetna Liberty, Aetna Freedom1525, Aetna Freedom2030, and Aetna Freedom2035 are the same as those offered in the State's Employee Prescription Drug Plan, see applicable charts earlier on the page.


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Last Updated: Monday, 06/11/18