Brand or proprietary drugs that aren't preferred by the formulary. For two-tier benefit designs, enter the same cost-share as for Rx Preferred Brand in this category. In three-tier designs, these drugs have the highest member cost-share. In four-tier designs, these drugs have the next-to-highest member cost-share:
The SBC will likely describe separate benefits for retail versus mail-order. Enter only the retail benefit and ignore the mail benefit: