Brand name you pay 50 % up to $65, retail generic $15.00 co-pay, Mail – order generic $25.00, Mail- order Brand is 50% up to $130.00.
We provide benefits for smoking cessation. Benefits are payable for one treatment cycle per calendar year and are subject to the lifetime max shown in the Benefit Summary. The one course of treatment must be prior authorized with Elixir at 1-877-437-9012.
Your drug plan through Elixir is as follows:
The maximum amount you’ll pay out-of-pocket for prescription drugs in a calendar year is $1,500 per member or $3,000 per member for family coverage.