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Express Scripts : Non-AFSCME Pharmacy Coverage <br />Coverage Period 1-1-2017-12-31-2018 <br />Summery of 8ene0ta ead Coantaga: What Ihle Plan coven s What it costs c mine,. foe PLAN A m MMO Hi 100%Plan <br />PLAN 0-MMO Lo 90110 Plan <br />PlviBil$U-Avid/!2i idial -90 A, to"i,, . ••.• <br />BW0 Samene lm 1Pba A: Reuil -R, tta,4. N \teil <br />(:mmc drvhs Plan At $i-Ilna➢/ Nuuvu6 - <br />$1159.-td.0 I90Jry'rvPPIY <br />ddo - <br />{Paf lb and JNIP a' <br />(➢In4$t6 A J/$25 <br />daaJ It Jay pPIY WO - <br />Ao-dt P R <br />i`NJY <br />1 <br />PPif <br />i1 a,.mvIWN <br />11ai <br />". <br />M t$'1^-ems <br />�P6n <br />PI D14uR 1ldY PNY <br />I� <br />dabl -' <br />fr $M II lJ <br />p f eeJbavddvgv Shi 4l.. drl <br />San�NR :l appl$ <br />e I Y PPh' <br />� h ,rvok I6 {AliPool 1{J hllt- <br />r` <br />fN �PlvaiN/A <br />90A ppll -- <br />-:._- <br />1 <br />bmta Dt P`nth, ,dkvh,i iW% ,d <br />bpccbLYJrvR. ISt-. Rcml <br />� <br />\ctwak duo9h S,tw, pL Y ki, the <br />ettA, mvawnh u ra it (3d dap) - <br />Summary of Benefda and Coveraga: Mat this Plan Covets &Mat it Costa coverage for. PLAN A • MMO HI 100%Plo <br />PIm 1Mail-90 Air n"lY <br />4ansncdrvy+ PI+o A:35-Rail/ Ne—k� Plna ..... d-3i AYrvPPIY\Ivl- <br />j <br />I'laa3.129 RvuI SA <br />Smn to M1lai 9n A" t P7 <br />I PrzhnN Ito"diva <br />H <br />NhJ <br />Ph. to R J/$+5 <br />Rthil. <br />Nenvk �Pbn A.ltctid NdiYraPPlpM1ival- <br />Me <br />A. <br />-: -� <br />�$van,peknnl <br />Platt QS A $ <br />P87.w-matt <br />PI D Aeu 111 dar PPIy <br />bil IDdjY PPb <br />Plan{ A nil 34 dq,upplyUa:l- <br />Metwt <br />bwnddrv8t <br />tl n:N/A <br />kl <br />90 dtr ePP7 <br />�me h, <br />9Pw 7.m�h txrsa <br />3pavbydng <br />ISamcaa Nttn] <br />S.mnk <br />ILimRh, ph cp <br />mmcdav l�nah i; vlatl (Jd data) <br />1.rno oo <br />�;I-POAARY OF PI "I DEWN CHANCES <br />ec.rcrn c •• in must , the hra nA Pin .. <br />with brand name Rat genPF i <br />E <br />Sppes-W `,:fM s <br />35 <br />--- Feral Table <br />