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CIS Rx Plan Benefit Summary Effective January 1, 2026 – December 31, 2026 This pharmacy plan is insured by CIS but administered by Regence BlueCross BlueShield (BCBS) of Oregon. This means that CIS, not Regence BCBS, pays for your covered pharmacy services and supplies. Prescription Medication Benefit At the Pharmacy (30-day supply) Member Pays At the Pharmacy (90-day supply) or Mail Order thru Amazon (90-day supply) Member Pays Individual deductible per calendar year No deductible Out-of-pocket maximum per calendar year $2,500 Individual / $7,500 family Tier 1 (Preferred Generic) $10 copay $20 copay Tier 2 (Non-Preferred Generic) $10 copay $20 copay Tier 3 (Preferred Brand) $40 copay $80 copay Tier 4 (Non-Preferred Brand) $100 copay $200 copay Tier 5 (Generic and Preferred Brand Specialty) $50 copay Generic Specialty $100 copay Preferred Brand Specialty N/A Tier 6 (Non-Preferred Specialty) $200 copay N/A Compound Medications $40 copay N/A Limitations and Exceptions Prescription drugs not on the Drug List are not covered, unless an exception is approved. No charge for certain preventive medications and immunizations, including those specifically designated as preventive for treatment of chronic diseases that are on the Optimum Value Medication List. Cost shares for insulin will not exceed $35 / 30-day supply or $105 / 90-day supply. Covered drugs limited to: Up to 90-day supply for retail prescription Up to 90-day supply for home delivery prescription Up to 30-day supply for specialty drug prescription Up to 30-day supply for compound medications Specialty Medications must be filled through Accredo Specialty Pharmacy. If you fill a brand drug or specialty drug when there is an equivalent generic drug or specialty biosimilar drug available, you pay the difference in cost in addition to the copayment and/or coinsurance, unless your provider specifies "dispense as written." More information about prescription drug coverage, including tier specific information, is available at