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Concert Health Plan
2605 W 22nd St. Suite 25
Oak Brook, Illinois 60523
Phone: (630) 990-1090
Customer Service: (866) 818-3106

Pharmacy Plans

Pharmacy Plan Options 2008
RC	$300 INDIVIDUAL RX DEDUCTIBLE Retail Pharmacy-$15 Generic/$35 Brand/$70 Non-Formulary 25% co-insurance on Specialty Drugs to o-o-p of $5,000 for Specialty Drugs Mail order-$30 Generic/$70 Brand/$140 Non-Formulary
RD	Retail Pharmacy-$20 Generic/$50 Brand/$75 Non-Formulary 25% co-insurance on Specialty Drugs to o-o-p of $5,000 for Specialty Drugs Mail order-$40 Generic/$100 Brand/$150 Non-Formulary
RE	Retail Pharmacy-$25 Generic/$50 Brand/$75 Non-Formulary 25% co-insurance on Specialty Drugs to o-o-p of $5,000 for Specialty Drugs Mail order-$50 Generic/$100 Brand/$150 Non-Formulary
RG	Subject to Medical Deductible Mail order-$30 Generic/$70 Brand/$100 Non-Formulary Retail Pharmacy-$15 Generic/$35 Brand/$50 Non-Formulary
RJ	Retail Pharmacy-$25 Generic/$50 Brand/$100 Non-Formulary 25% co-insurance on Specialty Drugs o-o-p of $5,000 for Specialty Drugs Mail order-$50 Generic/$100 Brand/$150 Non-Formulary
RK	$500 Annual RX Deductible Retail Pharmacy-$25 Generic/$50 Brand/$100 Non-Formulary 25% co-insurance on Specialty Drugs o-o-p of $5,000 for Specialty Drugs Mail order-$50 Generic/$100 Brand/$150 Non-Formulary
RL	Pharmacy-$20 Generic/$50 Brand/$70 Non-Formulary 25% co-insurance on Specialty Drugs o-o-p of $5,000 for Specialty Drugs Mail order-$40 Generic/$100 Brand/$140 Non-Formulary
RM	Retail Pharmacy-$15 Generic/$35 Brand/$50 Non-Formulary 25% co-insurance on Specialty Drugs o-o-p of $5,000 for Specialty Drugs Mail order-$37.50 Generic/$87.50 Brand/$125 Non-Formulary
R1	Retail Pharmacy-$5 Generic/$15 Brand/$50 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$10 Generic/$30 Brand/$100 Non-Formulary
R2	Retail Pharmacy-$10 Generic/$25 Brand/$50 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$20 Generic/$50 Brand/$100 Non-Formulary
R3	Retail Pharmacy-$15 Generic/$35 Brand/$70 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$30 Generic/$70 Brand/$140 Non-Formulary
R4	Retail Pharmacy-$5 Generic/$15 Brand/$50 Non-Formulary Mail order-$10 Generic/$30 Brand/$100 Non-Formulary
R5	Retail Pharmacy-$10 Generic/$25 Brand/$50 Non-Formulary Mail order-$20 Generic/$40 Brand/$100 Non-Formulary
R6	Retail Pharmacy-$15 Generic/$35 Brand/$50 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$20 Generic/$40 Brand/$100 Non-Formulary
R7	Retail Pharmacy-$15 Generic/$35 Brand/$50 Non-Formulary Mail order-$30 Generic/$70 Brand/$100 Non-Formulary
R8	Retail Pharmacy-$15 Generic/$35 Brand/$70 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$30 Generic/$70 Brand/$140 Non-Formulary
R9	Retail Pharmacy-$15 Generic/$35 Brand/$50 Non-Formulary 25% co-insurance on Specialty Drugs to an o-o-p of $5,000 for Specialty Drugs Mail order-$30 Generic/$70 Brand/$100 Non-Formulary

When a generic is available, but the pharmacy dispenses the brand name medicine for any reason, the participant will pay the difference between the brand name medicine and the generic plus the generic co-payment.

Prescriptions for maintenance and long-term medication may be initially filled at a retail pharmacy for up to a sixty daysupply but all additional refills must be obtained through mail order.