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Prescription drug coverage

Tier PPO ChoiceNet PPO Best Buy HSA PPO HMO
1 $5 $5 Deductible, then 20% coinsurance $5
2

$10

$10 Deductible, then 20% coinsurance

$10

3 25%
coinsurance1
25%
coinsurance1
Deductible, then 20% coinsurance 25%
coinsurance1
4 40%
coinsurance2
40%
coinsurance2
Deductible, then 20% coinsurance 40%
coinsurance2

1 $25 minimum, $50 maximum
2 $40 minimum, $80 maximum

Tier definitions:

Tier 1: Lowest Copay $
Tier 1 is made up of lower costing generic drugs that have been selected by Harvard Pilgrim. These drugs contain the same active ingredients as their brand-name counterparts. You pay the lowest Copayment or Coinsurance amount for Tier 1 drugs.
Tier 2: Lowest Copay $$
Tier 2 is primarily made up of higher costing generic drugs. These drugs contain the same active ingredients as their brand-name counterparts. Tier 2 may also include brand-name drugs that Harvard Pilgrim has determined to be more effective, less costly or to have fewer side effects than similar medications.

Tier 3: Middle copay $$$
Tier 3 is primarily made up of brand name drugs for which generic equivalents are not available. These drugs have been selected by Harvard Pilgrim based on review of the relative safety, effectiveness and cost of the many brand name drugs on the market. Tier 3 may also include generic drugs that Harvard Pilgrim has determined to be more costly than their brand name alternatives.

Tier 4: Highest Copay $$$
Tier 4 is made up of drugs that Harvard Pilgrim has not included in Tier 1, Tier 2, or Tier 3. You pay the highest Copayment or Coinsurance Amount for Tier 4 drugs.