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, coming soon) |
| Basic Rx $10/20 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $10/20 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $10/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/30 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/30 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| 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, coming soon) |
| Enhanced Rx $10/15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $5/10/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $5/10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| 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, coming soon) |
| Rx Spectrum $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Not Marketed HMO/POS plans | Download and size |
|---|---|
| Basic Rx $10/15 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $10/15 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/25 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Basic Rx $15/25 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Premier Rx $0/10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Premier Rx $0/10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Premier Rx $0/10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
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, coming soon) |
| Enhanced Rx $5/10/25 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/15/30 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/15/30 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/15/30 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/20/35 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/30/50% $100 max with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced+ Rx $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/20/35 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/20/35 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/20/35 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/25/40 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $10/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/45 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/30/50 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/40/70 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $0 Pharmacy Deductible | English (PDF, 1MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $20/40/60 with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Enhanced Rx - Value Formulary $15/20%/30%/40% with $250 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum Riders for PPO/EPO plans | Download |
|---|---|
| Rx Spectrum $10/25/40 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/30/45 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/40/70 with $0 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/30/45 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
| Rx Spectrum - Value Formulary $15/40/70 with $150 Pharmacy Deductible | English (PDF, 1 MB) Spanish (PDF, coming soon) |
