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| This program is designed to educate you on the use of generic and other low cost brand name drugs. This program is designed to help you find drugs within the same therapeutic class as a drug you may currently be taking. Most of all this program is designed to save you money on your prescription drug costs. |
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| Drug quantities listed must be adhered to in order to receive Tier pricing. Any change in listed quantity may result in higher prices. Company cannot be responsible for changes in network pharmacies which accept this program. |
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| Brand name drugs are signifed in UPPER case text. Generic drugs are signifed in Standard case text. |
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| This formulary has the following tiers: |
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