Plan Name
| BIN | |
| PCN | |
| Rx Group |
| Plan Year | 01/01 – 12/31 |
Need to know plan updates will be populated here
Plan Option 1
| Retail 30 | Retail 90 | Mail Order 90 | Specialty Pharmacy | |
| Preferred Generics | ||||
| Preferred Brands | ||||
| Non-Preferred Drugs | ||||
Plan Option 2
Plan Option 3
Plan Option 4