UAW Retiree Medical Benefits Trust
Prescription Drug Co-Payment

The Pharmacy Benefit Manager has negotiated discounted prices for prescription drugs under the plan when the prescription is filled at participating retail and mail order pharmacies. If the discounted price is lower than your co-payment, you will be charged the lower amount.

All Plans:
2017 Copays

(one month supply)

Mail Order
(90-day supply through 
Express Scripts)

Tier 1 (Generic Drugs)



Tier 2 (Preferred Brand)



Tier 3 (Non-Preferred Brand)



Payment Methods for Mail-Order Prescriptions:
        • Check                • e-Check            • Money Order           • Credit Card

Extended payment options are available. Call Member Services 1-866-662-0274 for additional information. Members are encouraged to join the Express Scripts automatic payment program to allow for credit card payments and uninterrupted service. Members can enroll online at or call 1-800-948-8779.

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