Erickson Advantage Signature with Drugs (HMO-POS) Drug Coverage

Erickson Advantage | HMO
Plan website: www.EricksonAdvantage.com
Plan Phone Number: (800) 989-1389
U.S. News Preferred Broker Phone: (888) 245-3931

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Drug Coverage

For drugs on formulary at in in-network pharmacy.

Drug Tier Name In Network 30 days In Network 90 days Mail Order 90 days
Tier 1: Preferred Generic $5 $15 $10
Tier 2: Non-Preferred Generic $10 $30 $20
Tier 3: Preferred Brand $45 $135 $125
Tier 4: Non-Preferred Brand $85 $255 $245
Tier 5: Specialty Tier 33% coinsurance 33% coinsurance 33% coinsurance

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