5 Copay $30 Copay
Transcrição
5 Copay $30 Copay
Prescription PlanSavings Design - Regional Drug - MEDICAL HOME HMO PLAN See how Vantage can save you money on generic and brand name drugs. Look at the chart below to determine what your cost savings would be on some of the most commonly used drugs. Make sure to ask a Vantage representative to help you compare your drug costs on all your prescription drugs. Expen$ive $5 Copay BRAND NAMES WITH VANTAGE Compare to Vantage TIER 1 GENERICS Celexa Citalopram WITH VANTAGE Cozaar / Hyzaar Losartan / Losartan-HCTZ TIER 2 PREFERRED BRANDS Effexor XR Venlafaxine ER Flonase Fluticasone Propionate Levaquin Levofloxacin Lotrel Amlodipine-benazepril Lortab, Lorcet, Vicodin Hydrocodone/Acetaminophen Mobic Meloxicam Norvasc Amlodipine Paxil Paroxetine Pravachol Pravastatin Prevacid Lansoprazole Prilosec Omeprazole Protonix Pantoprazole Tenormin Atenolol Toprol XL Metoprolol Succinate Wellbutrin XL Bupropion ER Advair Diskus Boniva Tablets Byetta requires prior authorization Byetta Bystolic Celebrex Colcrys Crestor Cymbalta Diovan/Diovan HCT Evista Exforge/Exforge HCT Lipitor Lovaza Plavix Pristiq Pulmicort Tamiflu Zithromax Azithromycin Zocor Simvastatin YOU CAN ALSO BENEFIT FROM A $30 Copay The Vantage Medical Home HMO prescription drug benefit for State employees has four copay/coinsurance levels, including Tier 3 Non-Preferred Brands with a $50 copay, and Tier 4 Specialty Drugs with 20% coinsurance. The drugs listed above are an example and do not represent the full range of covered drugs available on the Vantage plan. Select medications may have quantity limits and/or require prior authorization or step therapy. VHP518 Page 2 OGB APPROVED 9/27/2011 Vantage Health Plan · 130 DeSiard Street · (888) 823-1910 · www.VHP-StateGroup.com