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Pensions and Benefits
STATE HEALTH BENEFITS PROGRAM and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM

EMPLOYEE PRESCRIPTION DRUG PLAN COPAYMENTS

STATE EMPLOYEES ENROLLED IN THE SHBP

NJ DIRECT15, Aetna HMO, or Cigna HealthCare HMO

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
01-30 days $3 $10 $25
31-60 days $6 $20 $50
61-90 days $9 $30 $75


MAIL ORDER COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
01-90 days $5 $15 $40

NJ DIRECT1525, Aetna1525, or Cigna1525

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
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 Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
01-90 days $18 $40 $88

NJ DIRECT2030, Aetna2030, or Cigna2030

RETAIL PHARMACY COPAYMENT AMOUNTS
Up to a 90-day Supply
Supply Generic Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
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 Brand Name Drug
without generic equivalents
Brand Name Drug
with generic equivalents
01-90 days $5 $36 $92

NJ DIRECT HD4000 or HD1500, Aetna HD4000 or HD1500, or Cigna HD4000 or HD1500

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

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


LOCAL GOVERNMENT EMPLOYEES ENROLLED IN THE SHBP

NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HealthCare 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

NJ DIRECT1525, Aetna1525, or Cigna1525

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

NJ DIRECT2030, Aetna2030, or Cigna2030

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

NJ DIRECT HD4000 or HD1500, Aetna HD4000 or HD1500, or Cigna HD4000 or HD1500

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

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


LOCAL EDUCATION EMPLOYEES ENROLLED IN THE SEHBP

NJ DIRECT10, NJ DIRECT15, Aetna HMO, or Cigna HealthCare 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

NJ DIRECT1525, Aetna1525, or Cigna1525

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

NJ DIRECT2030, Aetna2030, or Cigna2030

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

NJ DIRECT HD1500, Aetna HD1500, or Cigna HD1500

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

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

 
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