Hillcrest - Pharmacy Benefits

Hillcrest Logo

Annual Deductible
$50 Individual/$150 Family
(does not apply to preferred generics)

Retail	30 days
Preferred Generic	$5 (deductibe waived)
Non-preferred Generic	$10
Preferred Brand	30%
Non-Preferred Brand	50%
Maintenance Benefits*	90 days
Preferred Generic	$10 (deductible waived)
Preferred Brand	30%
Self-Administered Injectable Pharmacy Drugs Prior Authorization required for al Self-Administered Injectable Pharmacy Drugs
Supply Limit	30 days
Generic	30% copay to a $150 maximum per prescription
Brand	30% copay to a $150 maximum per prescription

*Maintenance quantities must be obtained from a Scott & White Health Plan pharmacy.

Scott & White Health Plan