January 2026 prescription drug options
You can offer your clients prescription drug options with a range of copayments and rates. These options – more than 85 in all – cover drugs and supplies in the Blue Shield Drug Formulary, including drugs and devices, contraceptives, diabetic supplies and more. You'll have flexibility when offering affordable choices that enhance your clients' medical plan.
Select a drug coverage plan to accompany the health plan your client is interested in. The information below is effective January 1, 2026 for groups with 101 or more eligible employees.
Prescription drug options
2026 Rx Riders for HMO and POS plans
| Basic Rx Riders for HMO and POS plans | Download and size |
|---|---|
| Basic Rx $10/20 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $10/20 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $10/20 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $10/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/30 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/30 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx Riders for HMO and POS plans | Download and size |
|---|---|
| Enhanced Rx $10/15/30 with $0 Pharmacy Deductible | English (PDF, 1.1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $5/10/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $5/10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 441 KB) |
| RX Spectrum Riders for HMO and POS plans | Download and size |
|---|---|
| Rx Spectrum $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| RX Spectrum Riders for HMO and POS plans | Download and size |
|---|---|
| Rx Spectrum $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 443 KB) |
| Not Marketed HMO/POS plans | Download and size |
|---|---|
| Basic Rx $10/15 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $10/15 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Basic Rx $15/25 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Premier Rx $0/10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Premier Rx $0/10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Premier Rx $0/10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
| Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 442 KB) |
2026 Rx Riders for PPO/EPO plans
| Enhanced Rx Riders for PPO/EPO Plans | Download and Size |
|---|---|
| Enhanced Rx $5/10/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $5/10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/15/30 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/15/30 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/20/35 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 448 KB) |
| Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/20/35 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 459 KB) |
| Rx Spectrum Riders for PPO/EPO plans | Download |
|---|---|
| Rx Spectrum $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Not Marketed PPO/EPO plans | Download |
|---|---|
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, 451 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
| Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, 451 KB) |
