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CIP Prescription Copayments 

 
Below are the copayments for FY2014 and FY2015.

    CCHP

 HMO & OAP

Formulary Category
(30-day supply)

 FY2014 and FY2015

 FY2014 and FY2015

 Generic

 $12.50

 $12.00

 Preferred Brand

 $25.00

 $24.00

 Non-Preferred Brand

 $50.00

 $48.00

 Specialty

 $100.00

96.00

Updated 04/30/14