Non-standard Category 4 benefits

Non-standard Pharmacy Benefit Exceptions

If your Category 4 prescription drug cost is 20% up to $100, some drugs reside in different categories than drugs on the standard 4-Category design. If your medication is to treat one of the conditions listed below, or is a type of medication listed below, select the appropriate link to find the Category list. As on all Category lists, we encourage you to discuss your options with your healthcare provider. Selecting a medication in a lower-numbered category will cost you less.

Depression

GERD--Stomach Acid--Ulcer

High Blood Pressure

High Cholesterol

Inflammatory Bowel

Nasal Steroids

Topical Immunosuppressants

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