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  1. CMS
  2. Employee Services
  3. Benefits
  4. Local Government Health Plan

LGHP Prescription Copayments 

 

FY2014 and FY2015 Copayments
30-Day Supply 

HMO 

OAP

 Local Care
Health Plan (LCHP)

Local Consumer-Driven Health Plan (LCDHP)

 Generic

 $12.00

 $12.00

 $12.50

 Member pays 30% coinsurance

 Preferred Brand

 $24.00

 $24.00

 $25.00

 Member pays 40% coinsurance

 Nonpreferred Brand

 $48.00

 $48.00

 $50.00

 Member pays 50% coinsurance

 Specialty

 $96.00

 $96.00

 $100.00

 N/A

Updated 04/30/14