T2679 Exhibit A - Stand Alone Prescription Drug Plan 08.06.26.pdf
PDF 899 KB Posted
- Solicitation number
- 27DPP01337
- Issued by
- New Jersey
About this file
This document is a Prescription Drug Plan Design exhibit from the New Jersey Division of Pensions & Benefits for the State of New Jersey's Employee Benefits Pharmacy Benefits Management contract (T2679, contract number 27DPP01337) for the plan year 2026. The exhibit presents comprehensive side-by-side comparisons of prescription drug coverage options across multiple employee groups, including CWA Members, Union Negotiated and Non-Aligned plans, State Active Group employees, Local Government Active Group employees, and Local Education Active Group employees. The plans are offered through two primary carriers—Aetna and Horizon—with multiple plan designs including Freedom plans, DIRECT plans, HMO plans, Liberty Plus, OMNIA, and High Deductible Health Plan (HDHP) options. Each plan tier includes varying copayment structures for retail and mail-order prescriptions categorized by generic, preferred brand, non-preferred brand, and specialty medications. The prescription drug annual out-of-pocket maximums are standardized across most plans at $2,120 for individuals and $4,240 for families, though Local Education plans offer a lower maximum of $1,600/$3,200. Effective January 1, 2026, GLP-1 weight loss drugs (Wegovy, Saxenda, and Zepbound) receive special pricing with a $45 copayment for 30-day retail supplies and $135 copayment for 90-day mail-order supplies, excluding High Deductible Health Plans.
Pricing structures vary significantly across plan designs, with retail generic copayments ranging from $3 to $10 depending on the plan type and employee group, while mail-order prescriptions generally feature lower or no copayments for generics. Preferred brand copayments range from $10 to $20 for retail and $15 to $50 for mail-order, while non-preferred brands carry substantially higher costs ranging from $10 to $75 for retail. For members whose prescription drug coverage is provided through the medical plan rather than standalone prescription drug plans, coinsurance rates apply at 10 percent, 15 percent, or 20 percent depending on plan tier. High Deductible Health Plans require prescription drug coverage through the SHBP medical plan and are subject to the plan's deductible and coinsurance amounts. Specialty prescriptions must be filled through Optum Specialty Pharmacy, with contact information provided for patient care coordination. The document indicates that local government and local education employers have flexibility to select from the State Health Benefits Plan's Prescription Drug Plans, purchase their own coverage, or receive prescription drug coverage through the SHBP medical plan, with coverage options effectively for plan year 2026.
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T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management
CWA MEMBERS
STATE ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
HA-1156-0426
Side-by-Side Rx Comparison 26 Aetna
CWA Unity Freedom 26 Horizon
CWA Unity DIRECT 26 Aetna HMO 26 Horizon HMO1 26 Aetna
Liberty Plus 26 Horizon OMNIA Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments2
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Retail: Specialty Copayments3 N/A N/A N/A N/A N/A N/A
Mail: Generic Copayments
$10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments2
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Mail: Specialty Copayments (30-day supply)3 $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
Effective January 1, 2026, GLP-1 weight loss drugs Wegovy, Saxenda, and Zepbound have a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
CWA MEMBERS
STATE ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
HA-1156-0426
Side-by-Side Rx Comparison 26 Aetna
Freedom HDHigh* 26 Horizon
NJ DIRECT HDHigh* 26 Aetna
Freedom HDLow*
26 NJ DIRECT
HDLow* Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments Retail: Non-preferred Brand Copayments Retail: Brand w/ Generic available Copayments2
Retail: Specialty Copayments3
Mail: Generic Copayments Mail: Preferred Brand Copayments Mail: Non-preferred Brand Copayments Mail: Brand w/ Generic available Copayments2
Mail: Specialty Copayments (30-day supply)3
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
Notes: Retail - 30 day supply. Mail - 90 day supply.
Oral contraceptive coverage is available under the medical and prescription plans.
For all plans excluding the HDLow and HDHigh plans, mail order is mandatory for maintenance prescriptions.
*HD = High Deductible Health Plan.
| 1 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
| 2 | You pay the cost difference between the brand drug and the generic drug. |
| 3 | All specialty prescriptions must be filled at Optum Specialty Pharmacy. Call 1-888-341-8579 to speak with an Optum patient care coordinator. |
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
Effective January 1, 2026, GLP-1 weight loss drugs Wegovy, Saxenda, and Zepbound have a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
http://www.nj.gov/treasury/pensions
UNION NEGOTIATED AND NON-ALIGNED PLANS PRESCRIPTION PLAN
DESIGN - PLAN YEAR 2026 STATE ACTIVE GROUP
Pensions & Benefits
HA-1157-0426
Side-by-Side Rx Comparison 26 Aetna Freedom 26 Horizon NJ DIRECT 26 Aetna HMO 26 Horizon HMO1
26 Aetna Liberty Plus 26 Horizon OMNIA
Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments2
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Retail: Specialty Copayments3 N/A N/A N/A N/A N/A N/A
Mail: Generic Copayments $10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments2
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Mail: Specialty Copayments (30-day supply)3 $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
UNION NEGOTIATED AND NON-ALIGNED PLANS PRESCRIPTION PLAN
DESIGN - PLAN YEAR 2026 STATE ACTIVE GROUP
Pensions & Benefits
HA-1157-0426
Side-by-Side Rx Comparison 26 Aetna
Freedom HDHigh* 26 Horizon
NJ DIRECT HDHigh* 26 Aetna
Freedom HDLow* 26 Horizon
NJ DIRECT HDLow* Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments Retail: Non-preferred Brand Copayments Retail: Brand w/ Generic available Copayments2
Retail: Specialty Copayments3
Mail: Generic Copayments Mail: Preferred Brand Copayments Mail: Non-preferred Brand Copayments Mail: Brand w/ Generic available Copayments2
Mail: Specialty Copayments (30-day supply)3
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
Note: Retail - 30 day supply. Mail - 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
* HD = High Deductible Health Plan.
| 1 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
| 2 | You pay the cost difference between the brand drug and the generic drug. |
Effective January 1, 2026, GLP-1 weight loss drugs Wegovy, Saxenda, and Zepbound have a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
Notes: Retail - 30 day supply. Mail - 90 day supply.
Oral contraceptive coverage is available under the medical and prescription plans.
For all plans excluding the HDLow and HDHigh plans, mail order is mandatory for maintenance prescriptions.
*HD = High Deductible Health Plan.
| 1 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
| 2 | You pay the cost difference between the brand drug and the generic drug. |
| 3 | All specialty prescriptions must be filled at Optum Specialty Pharmacy. Call 1-888-341-8579 to speak with an Optum patient care coordinator. |
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
STATE ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
HA-1153-0426
Side-by-Side Rx Comparison 26 Aetna Freedom
26 Horizon
NJ DIRECT
26 Aetna Freedom 15
26 Horizon
NJ DIRECT 15
26 Aetna Freedom 1525
26 Horizon
NJ DIRECT 1525
Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Retail: Specialty Copayments3 N/A N/A N/A N/A N/A N/A
Mail: Generic Copayments $10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Mail: Specialty Copayments (30-day supply)3 $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
HA-1153-0426
Side-by-Side Rx Comparison 26 Aetna
Freedom 2030 26 Horizon
NJ DIRECT 2030
26 Aetna
Freedom 2035 26 Horizon
NJ DIRECT 2035 26 Aetna HMO 26 Horizon HMO2
Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Retail: Specialty Copayments3 N/A N/A N/A N/A N/A N/A
Mail: Generic Copayments $10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Member pays the difference
Mail: Specialty Copayments (30-day supply)3 $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
HA-1153-0426
Side-by-Side Rx Comparison 26 Aetna
Liberty Plus 26 Horizon
OMNIA
26 Aetna
Freedom HDHigh* 26 Horizon
NJ DIRECT HDHigh* 26 Aetna
Freedom HDLow* 26 Horizon
NJ DIRECT HDLow* Retail: Generic Copayments $10 $10
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments $20 $20
Retail: Non-preferred Brand Copayments $75 $75
Retail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Retail: Specialty Copayments3 N/A N/A
Mail: Generic Copayments $10 $10
Mail: Preferred Brand Copayments $50 $50
Mail: Non-preferred Brand Copayments $150 $150
Mail: Brand w/ Generic available Copayments1
Member pays the difference
Member pays the difference
Mail: Specialty Copayments (30-day supply)3 $75 $75
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240
Notes: Retail - 30 day supply. Mail - 90 day supply.
Oral contraceptive coverage is available under the medical and prescription plans.
For all plans excluding the HDLow and HDHigh plans, mail order is mandatory for maintenance prescriptions.
* HD = High Deductible Health Plan.
| 1 | You pay the cost difference between the brand drug and the generic drug. |
| 2 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
| 3 | All specialty prescriptions must be filled at Optum Specialty Pharmacy. Call 1-888-341-8579 to speak with an Optum patient care coordinator. |
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
Effective January 1, 2026, GLP-1 weight loss drugs Wegovy, Saxenda, and Zepbound have a $45 copayment for a 30-day retail supply and a $135 copayment for a 90-day mail-order supply. (This does not apply to the HDHigh and HDLow plans.)
LOCAL GOVERNMENT ACTIVE GROUP PRESCRIPTION PLAN DESIGN -
PLAN YEAR 2026 AETNA AND HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison Aetna Freedom/ Freedom 2019*
Horizon NJ DIRECT/
NJ DIRECT 2019*
Aetna Freedom 10
Horizon
NJ DIRECT 10
Aetna Freedom 15
Horizon
NJ DIRECT 15
Retail: Generic Copayments $7 $7 $3 $3 $3 $3
Retail: Preferred Brand Copayments $16 $16 $10 $10 $10 $10
Retail: Non-Preferred Brand Copayments
Member pays difference1
Member pays difference1 $10 $10 $10 $10
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Preferred Brand Copayments $40 $40 $15 $15 $15 $15
Mail: Non-Preferred Brand Copayments
Member pays difference1
Member pays difference1 $15 $15 $15 $15
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
$2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
PLAN YEAR 2026 AETNA AND HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison Aetna
Freedom 1525 Horizon
NJ DIRECT 1525
Aetna
Freedom 2030 Horizon
NJ DIRECT 2030
Aetna
Freedom 2035 Horizon
NJ DIRECT 2035
Retail: Generic Copayments $7 $7 $3 $3 $72 $72
Retail: Preferred Brand Copayments $16 $16 $18 $18 $212 $212
Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 Member pays difference1,2 Member pays difference1,2
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1,2
Member pays difference1,2
Mail: Generic Copayments $0 $0 $0 $0 $0 $0
Mail: Preferred Brand Copayments $40 $40 $36 $36 $52 $52
Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 Member pays difference1,2 Member pays difference1,2
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1,2
Member pays difference1,2
Prescription Drug annual Out-of-Pocket Maximum
PLAN YEAR 2026 AETNA AND HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison Aetna HMO3 Horizon HMO3 Aetna Liberty Plus Horizon OMNIA Aetna
Freedom HDHigh** Horizon
NJ DIRECT HDHigh** Retail: Generic Copayments $3 $3 $7 $7
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments $10 $10 $16 $16
Retail: Non-Preferred Brand Copayments $10 $10 $35 $35
Retail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Mail: Generic Copayments $0 $0 $0 $0
Mail: Preferred Brand Copayments $15 $15 $40 $40
Mail: Non-Preferred Brand Copayments $15 $15 $88 $88
Mail: Brand w/ Generic Equivalent
Member pays difference1
Member pays difference1
Member pays difference1
Member pays difference1
Prescription Drug annual Out-of- Pocket Maximum
$2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
PLAN YEAR 2026 AETNA AND HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison Aetna
Freedom HDLow** Horizon
NJ DIRECT HDLow** Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments Retail: Non-Preferred Brand Copayments Retail: Brand w/ Generic Equivalent Mail: Generic Copayments Mail: Preferred Brand Copayments Mail: Non-Preferred Brand Copayments Mail: Brand w/ Generic Equivalent Prescription Drug annual Out-of- Pocket Maximum (Individual/Family)
* Members hired before July 1, 2019, will be enrolled in Aetna Freedom or Horizon NJ DIRECT. Members hired after July 1, 2019, will be enrolled in Aetna Freedom 2019 or Horizon NJ DIRECT 2019.
** HD = High Deductible Health Plan 1 You pay the cost difference between the brand drug and the generic drug.
| 2 | For maintenance prescription drugs, mail order is mandatory under Aetna Freedom 2035 and Horizon NJ DIRECT2035. |
| 3 | Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. |
Notes: Retail – 30 day supply. Mail – 90 day supply.
Oral contraceptive coverage is available under the medical and prescription plans.
Local government employers can select from the SHBP’s Prescription Drug Plans, purchase their own prescription drug coverage plan, or receive prescription drug coverage through the SHBP medical plan. Copayments shown above apply to the plans when coverage is through the SHBP’s Prescription Drug Plans. If prescription drug coverage is through the medical plan: Coinsurance is 10% for Aetna Freedom, Horizon NJ DIRECT, Aet-na Freedom 2019, Horizon NJ DIRECT 2019, Aetna Freedom 10, Horizon NJ DIRECT 10, Aetna Freedom 15, and Horizon NJ DIRECT 15; Coinsurance is 15% for Aetna Freedom 1525, Horizon NJ DIRECT 1525, Aetna Freedom 2030, and Horizon NJ DIRECT 2030; Coinsurance is 20% for Aetna Freedom 2035 and NJ DIRECT 2035. For High Deductible Health Plans, prescription drug coverage must be through the SHBP medical plan and is subject to the plan’s deductible and coinsurance amounts.
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
PLAN YEAR 2026 26 AETNA PLANS AND 26 HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison 26 Aetna Freedom 26 Horizon
NJ DIRECT
26 Aetna Freedom 10
26 Horizon
NJ DIRECT 10
26 Aetna Freedom 15
26 Horizon
NJ DIRECT 15
Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-Preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Retail: Specialty Copayments $75 $75 $75 $75 $75 $75
Mail: Generic Copayments $10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-Preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Mail: Specialty Copayments (30-day supply) $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum
PLAN YEAR 2026 26 AETNA PLANS AND 26 HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison 26 Aetna
Freedom 1525 26 Horizon
NJ DIRECT 1525
26 Aetna
Freedom 2030 26 Horizon
NJ DIRECT 2030
26 Aetna
Freedom 2035 26 Horizon
NJ DIRECT 2035
Retail: Generic Copayments $10 $10 $10 $10 $10 $10
Retail: Preferred Brand Copayments $20 $20 $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Retail: Specialty Copayments $75 $75 $75 $75 $75 $75
Mail: Generic Copayments $10 $10 $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Mail: Specialty Copayments (30-day supply) $75 $75 $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum
PLAN YEAR 2026 26 AETNA PLANS AND 26 HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison 26 Aetna HMO3 26 Horizon HMO3 26 Aetna
Liberty Plus 26 Horizon OMNIA 26 Aetna
Freedom HDHigh* 26 Horizon
NJ DIRECT HDHigh* Retail: Generic Copayments $10 $10 $10 $10
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments $20 $20 $20 $20
Retail: Non-preferred Brand Copayments $75 $75 $75 $75
Retail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Retail: Specialty Copayments $75 $75 $75 $75
Mail: Generic Copayments $10 $10 $10 $10
Mail: Preferred Brand Copayments $50 $50 $50 $50
Mail: Non-preferred Brand Copayments $150 $150 $150 $150
Mail: Brand w/ Generic available Copayments
Member pays the difference1
Member pays the difference1
Member pays the difference1
Member pays the difference1
Mail: Specialty Copayments (30-day supply) $75 $75 $75 $75
Prescription Drug annual Out-of-Pocket Maximum
$2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
PLAN YEAR 2026 26 AETNA PLANS AND 26 HORIZON PLANS
HA-1154-0526
Pensions & Benefits
Side-by-Side Rx Comparison 26 Aetna
Freedom HDLow* 26 Horizon
NJ DIRECT HDLow* Retail: Generic Copayments
Subject to deductible and coinsurance
Subject to deductible and coinsurance
Retail: Preferred Brand Copayments Retail: Non-preferred Brand Copayments Retail: Specialty Copayments Mail: Generic Copayments Mail: Preferred Brand Copayments Mail: Non-preferred Brand Copayments Mail: Specialty Copayments (30-day supply) Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)
* HD = High Deductible Health Plan 1 You pay the cost difference between the brand drug and the generic drug.
3 Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.
Notes: Retail – 30 day supply. Mail – 90 day supply.
Oral contraceptive coverage is available under the medical and prescription plans.
For all plans excluding the HDLow and HDHigh plan, mail order is mandatory for maintenance prescriptions.
Local government employers can select from the SHBP’s Prescription Drug Plans, purchase their own prescription drug coverage plan, or receive prescription drug coverage through the SHBP medical plan. Copayments shown above apply to the plans when coverage is through the SHBP’s Prescription Drug Plans. If prescription drug coverage is through the medical plan: Coinsurance is 10% for 26 Aetna Freedom, 26 Horizon NJ DIRECT, 26 Aetna Freedom 10, 26 Horizon NJ DIRECT 10, 26 Aetna Freedom 15, and 26 Horizon NJ DIRECT 15; Coinsurance is 15% for 26 Aetna Freedom 1525, 26 Horizon NJ DIRECT 1525, 26 Aetna Freedom 2030, and 26 Horizon NJ DIRECT 2030; Coinsurance is 20% for 26 Aetna Freedom 2035 and 26 NJ DIRECT 2035. For High Deductible Health Plans, prescription drug coverage must be through the SHBP medical plan and is subject to the plan’s deductible and coinsurance amounts.
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all information. Although every attempt at accuracy is made, it cannot be guaranteed.
HA-1155-1025
Pensions & Benefits
T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management
LOCAL EDUCATION ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
Side-by-Side Rx Comparison Aetna
Freedom10 Horizon
NJ DIRECT10
Aetna
Freedom15 Horizon
NJ DIRECT15
Retail: Generic Copayments $3 $3 $3 $3
Retail: Preferred Brand Copayments $10 $10 $10 $10
Retail: Non-Preferred Brand Copayments $10 $10 $10 $10
Mail: Generic Copayments $5 $5 $5 $5
Mail: Preferred Brand Copayments $15 $15 $15 $15 Mail: Non-Preferred Brand Copayments $15 $15 $15 $15
Prescription Drug annual Out-of- Pocket Maximum (Individual/Family) $2,120/$4,240 $2,120/$4,240 $2,120/$4,240 $2,120/$4,240
HA-1155-1025
Pensions & Benefits
T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management
LOCAL EDUCATION ACTIVE GROUP
PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026
Side-by-Side Rx Comparison Aetna NJEHP Horizon NJEHP
Aetna Garden State Health
Plan (GSHP) Retail: Generic Copayments $5 $5 $5
Retail: Preferred Brand Copayments $10 $10 $10
Retail: Non-Preferred Brand Copayments1
Member pays difference
Member pays difference
Member pays difference
Mail: Generic Copayments $10 $10 $10
Mail: Preferred Brand Copayments $20 $20 $20 Mail: Non-Preferred Brand Copayments1
Member pays difference
Member pays difference
Member pays difference
Prescription Drug annual Out-of- Pocket Maximum (Individual/Family) $1,600/$3,200 $1,600/$3,200 $1,600/$3,200
Note: Retail – 30 day supply. Mail – 90 day supply. Oral contraceptive coverage is available under the medical and prescription plans.
Local education employers can select from the SEHBP’s Prescription Drug Plans, purchase their own prescription druge coverage plan, or receive prescription drug coverage through the SEHBP medical plan. Copayments shown apply to the plans when coverage is through the SEHBP’s Prescription Drug Plans. If prescription drug coverage is through the medical plan: for Aetna Freedom10, Horizon NJ DIRECT10, Aetna Freedom15, and Horizon NJ DIRECT15, coinsurance is 10%; for Aetna and Horizon NJEHP and Aetna GSHP, copays are the same as if coverage through the SEHBP’s Prescription Drug Plan as show in the chart above.
You pay the applicable brand copayment listed above, plus the cost difference between the brand drug and the generic drug.
This publication is produced and distributed by the New Jersey Division of Pensions & Benefits — www.nj.gov/treasury/pensions This is a summary and not intended to provide all infor mation. Although every attempt at accuracy is made, it cannot be guaranteed.
www.nj.gov/treasury/pensions
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File details come from the government source that posted it. Updated .