Express Scripts - Prescription Plan Summary
GENERIC REIMBURSEMENT PLAN

Dauphin County Employees


Retail (30 days):
      Generic  $10.00
      Brand Preferred      $18.00
      Brand Non-Preferred       $36.00

Mail Order (90 days):
      Generic  $15.00
      Brand Preferred      $27.00
      Brand Non-Preferred       $54.00

You will pay a generic co-pay when you obtain a generic drug. If your drug is not available in generic form you will pay the applicable Preferred/Non-Preferred co-pay listed above.

When purchasing a brand preferred or brand non-preferred drug, when a generic equivalent is available, you will be charged the brand generic cost difference plus applicable co-pay.

This applies to 30-day Retail and 90-day mail order.

An Express Scripts card will be mailed to your home upon receipt of all census information.






2589 Interstate Drive
Harrisburg, PA  17110-9602
Phone: 717-526-4856
Fax: 717-651-9529
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