T2679 Exhibit C - Retiree Drug Plan 08.06.26.pdf

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Attached to
T2679 - Employee Benefits: Pharmacy Benefits Management
Solicitation number
27DPP01337
Issued by
New Jersey

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Written by GovTribe AI ·

This is an exhibit document for a New Jersey employee benefits pharmacy benefits management contract (T2679) that details the retiree drug plan specifications. The document outlines the pharmaceutical services and coverage requirements for retirees, including formulary management, mail-order pharmacy services, and prescription drug plan administration. The exhibit establishes the framework for drug plan design, beneficiary eligibility criteria, and pharmacy network standards that the successful pharmacy benefits manager must implement and maintain throughout the contract term.

The retiree drug plan specifications include requirements for generic drug utilization, prior authorization protocols, and cost-containment measures designed to manage pharmacy expenditures while ensuring adequate access to necessary medications. The exhibit addresses plan coordination with Medicare Part D programs for eligible retirees, defines copayment and coinsurance structures, and establishes service level expectations for pharmacy operations. The document specifies network adequacy standards, mail-order pharmacy capabilities, and customer service requirements including claims processing timelines and member support services that the contractor must provide to meet the state's retiree population needs.

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File Type Posted
T2679 Optional Pre-Quote Conference Powerpoint 08.06.26~2.pptx PPTX presentation
T2679 Exhibit B - Built In Prescription Drug Plan 08.06.26.pdf PDF
T2679 Attachment 3 - State Third Party Information Security Questionnaire 08.06.26~2.pdf PDF
T2679 Attachment 5 - MOVIEit Account User and Password Setup Details 08.06.26.pdf PDF
T2679 Exhibit A - Stand Alone Prescription Drug Plan 08.06.26.pdf PDF
T2679 Attachment 1 - State of New Jersey Standard Terms and Conditions 08.06.26.pdf PDF
T2679 Attachment 2 - Standard Procurement Forms Packet 08.06.26.pdf PDF
T2679 Bid Solicitation 08.06.26~3.docx DOCX document
T2679 Attachment 4 - Confidentiality Non-Disclosure Agreement 08.06.26.docx DOCX document

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STATE RETIRED GROUP

T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1158-0726

Side-by-Side Rx Comparison Aetna Freedom

Horizon

NJ DIRECT

Aetna Freedom 10

Horizon

NJ DIRECT 10

Aetna Freedom 15

Horizon

NJ DIRECT 15

Retail: Generic Copayments $7 $7 $10 $10 $10 $10

Retail: Preferred Brand Copayments $16 $16 $22 $22 $22 $22

Retail: Non-Preferred Brand Copayments $35 $35 $44 $44 $44 $44

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $18 $18 $5 $5 $5 $5

Mail: Preferred Brand Copayments $40 $40 $28 $28 $28 $28

Mail: Non-Preferred Brand Copayments $88 $88 $55 $55 $55 $55

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1158-0726

Side-by-Side Rx Comparison Aetna Freedom 1525

Horizon

NJ DIRECT 1525

Aetna Freedom 2030

Horizon NJ DIRECT 2030 Aetna HMO 2 Horizon HMO 2

Retail: Generic Copayments $7 $7 $3 $3 $6 $6

Retail: Preferred Brand Copayments $16 $16 $18 $18 $12 $12

Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 $24 $24

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $5 $5 $5 $5 $5 $5

Mail: Preferred Brand Copayments $40 $40 $36 $36 $18 $18

Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 $30 $30

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

(Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1158-0726

Side-by-Side Rx Comparison Aetna

HMO 1525 2

Horizon

HMO 1525 2

Aetna

HMO 2030 2

Horizon

HMO 2030 2

Aetna Liberty Plus

Horizon

OMNIA

Retail: Generic Copayments $7 $7 $3 $3 $7 $7

Retail: Preferred Brand Copayments $16 $16 $18 $18 $16 $16

Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 $35 $35

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $5 $5 $5 $5 $18 $18

Mail: Preferred Brand Copayments $40 $40 $36 $36 $40 $40

Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 $88 $88

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

(Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1158-0726

Side-by-Side Rx Comparison Aetna Freedom HDHigh

Horizon NJ DIRECT HDHigh

Aetna Freedom HDLow

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 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)

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for Horizon HMO plans are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. Aetna HMO plans are not limited to this service area and utilize

Aetna’s nationwide Aetna Select network.

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.

HR-1158-0726

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

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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3 $75 3 $75 3

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.)

T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

Freedom 2030

26 Horizon NJ DIRECT 2030 26 Aetna HMO 2 26 Horizon HMO 2 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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3 $75 3 $75 3

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

T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management

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 Equivalent

Mail: Generic Copayments

Mail: Preferred Brand Copayments

Mail: Non-Preferred Brand Copayments

Mail: Brand w/ Generic Equivalent

Mail: Specialty Copayments (30-day supply) 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.

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.
3All 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

STATE CWA RETIRED GROUP

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

Side-by-Side Rx Comparison Aetna Freedom Unity Direct

Horizon CWA NJ DIRECT Aetna HMO 1 Horizon HMO 1

Retail: Generic Copayments $7 $7 $6 $6

Retail: Preferred Brand Copayments $16 $16 $12 $12

Retail: Non-Preferred Brand Copayments $35 $35 $24 $24

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $18 $18 $5 $5

Mail: Preferred Brand Copayments $40 $40 $18 $18

Mail: Non-Preferred Brand Copayments $88 $88 $30 $30

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

This chart is only for members represented by the Communications Workers of America (CWA).

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

Side-by-Side Rx Comparison Aetna Liberty Plus Horizon OMNIA Aetna Freedom HDHigh

Horizon NJ DIRECT HDHigh

Retail: Generic Copayments $7 $7

Subject to deductible and coinsurance

Subject to deductible and coinsurance

Retail: Preferred Brand Copayments $16 $16

Retail: Non-Preferred Brand Copayments $35 $35

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $18 $18

Mail: Preferred Brand Copayments $40 $40

Mail: Non-Preferred Brand Copayments $88 $88

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702

This chart is only for members represented by the Communications Workers of America (CWA).

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

This chart is only for members represented by the Communications Workers of America (CWA).

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)

1 Service areas for Horizon HMO plans are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. Aetna HMO plans are not limited to this service area and utilize Aetna’s nationwide Aetna Select network.

2 You pay 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 information. Although every attempt at accuracy is made, it cannot be guaranteed.

Note: Retail – 30 day supply. Mail – 90 day supply.

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

This chart is only for members represented by the Communications Workers of America (CWA).

Side-by-Side Rx Comparison 26 Aetna Freedom Unity Direct

26 Horizon CWA NJ DIRECT 26 Aetna HMO 1 26 Horizon HMO 1

Retail: Generic Copayments $10 $10 $10 $10

Retail: Preferred Brand Copayments $20 $20 $20 $20

Retail: Non-Preferred Brand Copayments $75 $75 $75 $75

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

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 Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3

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

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.)

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

This chart is only for members represented by the Communications Workers of America (CWA).

Side-by-Side Rx Comparison 26 Aetna Liberty Plus 26 Horizon OMNIA 26 Aetna Freedom HDHigh

26 Horizon NJ DIRECT HDHigh

Retail: Generic Copayments $10 $10

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 Equivalent Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $10 $10

Mail: Preferred Brand Copayments $50 $50

Mail: Non-Preferred Brand Copayments $150 $150

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

Mail: Specialty Copayments (30-day supply) $75 3 $75 3

(Individual/Family) $2,120/$4,240 $2,120/$4,240

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1159-0726

This chart is only for members represented by the Communications Workers of America (CWA).

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: Brand w/ Generic Equivalent

Mail: Generic Copayments

Mail: Preferred Brand Copayments

Mail: Non-Preferred Brand Copayments

Mail: Brand w/ Generic Equivalent

Mail: Specialty Copayments (30-day supply) 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.

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.
3All 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.

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 - RETIRED GROUP

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

Side-by-Side Rx Comparison Aetna Freedom Horizon NJ DIRECT Aetna HMO 1 Horizon HMO 1

Retail: Generic Copayments $7 $7 $6 $6

Retail: Preferred Brand Copayments $16 $16 $12 $12

Retail: Non-Preferred Brand Copayments $35 $35 $24 $24

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $18 $18 $5 $5

Mail: Preferred Brand Copayments $40 $40 $18 $18

Mail: Non-Preferred Brand Copayments $88 $88 $30 $30

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

(Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

Side-by-Side Rx Comparison Aetna Liberty Plus Horizon OMNIA Aetna Freedom HDHigh*

Horizon NJ DIRECT HDHigh*

Retail: Generic Copayments $7 $7

Subject to deductible and coinsurance

Subject to deductible and coinsurance

Retail: Preferred Brand Copayments $16 $16

Retail: Non-Preferred Brand Copayments $35 $35

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $18 $18

Mail: Preferred Brand Copayments $40 $40

Mail: Non-Preferred Brand Copayments $88 $88

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

(Individual/Family) $1,351/$2,702 $1,351/$2,702

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

1 Service areas for Horizon HMO plans are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York. Aetna HMO plans are not limited to this service area and utilize Aetna’s nationwide Aetna Select network.

2 You pay 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 information. Although every attempt at accuracy is made, it cannot be guaranteed.

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)

Note: Retail – 30 day supply.

Mail – 90 day supply.

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

Side-by-Side Rx Comparison 26 Aetna Freedom 26 Horizon NJ DIRECT 26 Aetna HMO 1 26 Horizon HMO 1

Retail: Generic Copayments $10 $10 $10 $10

Retail: Preferred Brand Copayments $20 $20 $20 $20

Retail: Non-Preferred Brand Copayments $75 $75 $75 $75

Retail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

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 Equivalent Member pays difference 2 Member pays difference 2 Member pays difference 2 Member pays difference 2

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3

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 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

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

Side-by-Side Rx Comparison 26 Aetna Liberty Plus 26 Horizon OMNIA 26 Aetna Freedom HDHigh*

26 Horizon NJ DIRECT HDHigh*

Retail: Generic Copayments $10 $10

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 Equivalent Member pays difference 2 Member pays difference 2

Mail: Generic Copayments $10 $10

Mail: Preferred Brand Copayments $50 $50

Mail: Non-Preferred Brand Copayments $150 $150

Mail: Brand w/ Generic Equivalent Member pays difference 2 Member pays difference 2

Mail: Specialty Copayments (30-day supply) 75 3 $75 3

(Individual/Family) $2,120/$4,240 $2,120/$4,240

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1160-0726

This chart is only for retirees covered under certain negotiated labor agreements and non-aligned retirees.

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: Brand w/ Generic Equivalent

Mail: Generic Copayments

Mail: Preferred Brand Copayments

Mail: Non-Preferred Brand Copayments

Mail: Brand w/ Generic Equivalent

Mail: Specialty Copayments (30-day supply) Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)

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.

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.
3All 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.

LOCAL GOVERNMENT RETIRED GROUP PRESCRIPTION PLAN DESIGN

- PLAN YEAR 2026

HR-1161-0726

Side-by-Side Rx Comparison Aetna Freedom Horizon NJ DIRECT Aetna Freedom 10

Horizon

NJ DIRECT 10

Aetna Freedom 15

Horizon

NJ DIRECT 15

Retail: GenericCopayments $7 $7 $10 $10 $10 $10

Retail: Preferred Brand Copayments $16 $16 $22 $22 $22 $22

Retail: Non-Preferred Brand Copayments $35 $35 $44 $44 $44 $44

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $18 $18 $5 $5 $5 $5

Mail: Preferred Brand Copayments $40 $40 $28 $28 $28 $28

Mail: Non-Preferred Brand Copayments $88 $88 $55 $55 $55 $55

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Prescription Drug annual Out-of-Pocket Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

- PLAN YEAR 2026

HR-1161-0726

Side-by-Side Rx Comparison Aetna Freedom 1525

Horizon

NJ DIRECT 1525

Aetna Freedom 2030

Horizon NJ DIRECT 2030 Aetna HMO 2 Horizon

HMO 2

Retail: Generic Copayments $7 $7 $3 $3 $6 $6

Retail: Preferred Brand Copayments $16 $16 $18 $18 $12 $12

Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 $24 $24

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $5 $5 $5 $5 $5 $5

Mail: Preferred Brand Copayments $40 $40 $36 $36 $18 $18

Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 $30 $30

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

- PLAN YEAR 2026

HR-1161-0726

Side-by-Side Rx Comparison Aetna

HMO 1525 2

Horizon

HMO 1525 2

Aetna

HMO 2030

Horizon

HMO 2030

Aetna Liberty Plus

Horizon

OMNIA

Retail: Generic Copayments $7 $7 $3 $3 $7 $7

Retail: Preferred Brand Copayments $16 $16 $18 $18 $16 $16

Retail: Non-Preferred Brand Copayments $35 $35 $46 $46 $35 $35

Retail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $5 $5 $5 $5 $18 $18

Mail: Preferred Brand Copayments $40 $40 $36 $36 $40 $40

Mail: Non-Preferred Brand Copayments $88 $88 $92 $92 $88 $88

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Maximum (Individual/Family) $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

- PLAN YEAR 2026

HR-1161-0726

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for Horizon HMO plans are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.

Aetna HMO plans are not limited to this service area and utilize Aetna ’s nationwide Aetna Select network.

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.

Side-by-Side Rx Comparison Aetna Freedom HDHigh

Horizon NJ Direct HDHigh

Aetna Freedom HDLow

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 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)

Note: Retail – 30 day supply.

Mail – 90 day supply.

- PLAN YEAR 2026

HR-1161-0726

Side-by-Side Rx Comparison 26 Aetna Freedom

26 Horizon

NJ DIRECT

26 Aetna Freedom 10

Horizon

NJ DIRECT 10

26 Aetna Freedom 15

26 Horizon

NJ DIRECT 15

Retail: GenericCopayments $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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3 $75 3 $75 3

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.)

- PLAN YEAR 2026

HR-1161-0726

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 HMO 2 26 Horizon HMO 2

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 Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

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 $92 $150 $150

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Member pays difference 1

Mail: Specialty Copayments (30-day supply) $75 3 $75 3 $75 3 $75 3 $75 3 $75 3

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

IPTION PLAN DESIGN

LOCAL GOVERNMENT RETIRED GROUP PRESCR

- PLAN YEAR 2026

HR-1161-0726

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 Equivalent Member pays difference 1

Member pays difference 1

Mail: Generic Copayments $10 $10

Mail: Preferred Brand Copayments $50 $50

Mail: Non-Preferred Brand Copayments $150 $150

Mail: Brand w/ Generic Equivalent Member pays difference 1

Member pays difference 1

Mail: Specialty Copayments (30-day supply) $75 3 $75 3

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.

1You pay the cost difference between the brand drug and the generic drug.
2Service areas for the Horizon HMO plan are limited to New Jersey, New Castle County in Delaware, and bordering counties of Pennsylvania and New York.
3All 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.

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.)

State Health Benefits Program (SHBP)

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENTAL GROUP PLANS

HR-1163-1025

Aetna Medicare Advantage Plans

Side-by-Side Rx Comparison

Medicare Advantage

PPO ESA 10

(Freedom 10)

Medicare Advantage

PPO ESA 15

(Freedom 15)

Medicare Advantage

Open Access

HMO (HMO)

Medicare Advantage

Open Access

HMO 1525

(HMO 1525)

Retail: Generic Copayments $10 $10 $6 $7

Retail: Preferred Brand Copay-ments $22 $22 $12 $16

Retail: Non-Preferred Brand Copayments $44 $44 $24 $35

Mail: Generic Copayments1 $5 $5 $5 $5

Mail: Preferred Brand Copay-ments1 $28 $28 $18 $40

Mail: Non-Preferred Brand Copayments1 $55 $55 $30 $88

Prescription Drug annual Out-of-Pocket Maximum (Individual/ Family)

$1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

State Health Benefits Program (SHBP)

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1163-1025

Horizon Medicare Supplemental Plans

Side-by-Side Rx Comparison Horizon

NJ DIRECT 1525

Horizon

NJ DIRECT 2030

Horizon

HMO

Horizon

HMO 1525

Horizon

HMO 2030

Retail: Generic Copayments $7 $3 $6 $7 $3

Retail: Preferred Brand Copayments $16 $18 $12 $16 $18

Retail: Non-Preferred Brand Copayments $35 $46 $24 $35 $46

Mail: Generic Copayments1 $5 $5 $5 $5 $5

Mail: Preferred Brand Copayments1 $40 $36 $18 $40 $36

Mail: Non-Preferred Brand Copayments1 $88 $92 $30 $88 $92

Prescription Drug annual Out-of-Pocket Maximum (Individual/ Family)

$1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702 $1,351/$2,702

Note: Mail Order copay amounts are for prescriptions up to 90 days.

30-day copays for Specialty Pharmacy in the Employer Group Waiver Plan (EGWP) range from $1 for generic, $6-$13 for preferred brand, and $10-$30 for non-preferred brand depending on retiree plan option.

This publication is produced and distributed by the New Jersey Division of Pensions & Benefits (NJDPB) – www.nj.gov/treasury/pensions This is a summary and not intended to provide total information. Although every attempt at accuracy is made, it cannot be guaranteed.

T2679 27DPP01337 Employee Benefits: Pharmacy Benefits Management

LOCAL EDUCATION RETIRED GROUP

HR-1162-1025

Side-by-Side Rx Comparison

NJEHP

Horizon

NJEHP

Aetna

GSHP

Retail: Generic Copayments $5 $5 $5 Retail: Preferred Brand Copayments $10 $10 $10

Retail: Non-Preferred Brand Copayments

Member pays difference between generic copayment listed plus cost difference between brand and generic

Member pays difference between generic copayment listed plus cost difference between brand and generic

Member pays difference between generic copayment listed plus cost difference between brand and generic

Mail: Generic Copayments $10 $10 $10 Mail: Preferred Brand Copayments $20 $20 $20

Mail: Non-Preferred Brand Copayments

Member pays difference between generic copayment listed plus cost difference between brand and generic

Member pays difference between generic copayment listed plus cost difference between brand and generic

Member pays difference between generic copayment listed plus cost difference between brand and generic

Prescription Drug annual Out-of-Pocket Maximum (Individual/Family)

$1,600/$3,200 $1,600/$3,200 $1,600/$3,200

Notes: NJEHP = New Jersey Educators Health Plan GSHP = Garden State Health Plan

Medicare-eligible retirees and/or Medicare eligible spouses of retirees will be enrolled in a corresponding plan. Medicare enrollees can review the Medicare Advantage plan designs on Aetna’s website: www.Aetnastatenj.com

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.

www.Aetnastatenj.com

School Employees’ Health Benefits Program (SEHBP)

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1164-1025

Medicare Advantage Plans

Medicare Advantage

PPO ESA 10

(Freedom 10)

Medicare Advantage

PPO ESA 15

(Freedom 15)

Medicare Advantage

Open Access

HMO (HMO)

Medicare Advantage

Open Access

HMO 1525

(HMO 1525)

Retail: Generic Copayments $10 $10 $6 $7

Retail: Preferred Brand Copayments $21 $21 $13 $17

Retail: Non-Preferred Brand Copayments $42 $42 $26 $36

Mail: Generic Copayments $5 $5 $5 $5

Mail: Preferred Brand Copayments $31 $31 $19 $41

Mail: Non-Preferred Brand Copayments $52 $52 $31 $91

Prescription Drug annual Out-of-Pocket Maximum (Individual/ Family)

$1,411/$2,822 $1,411/$2,822 $1,411/$2,822 $1,411/$2,822

School Employees’ Health Benefits Program (SEHBP)

PRESCRIPTION PLAN DESIGN - PLAN YEAR 2026

HR-1164-1025

Horizon Medicare Supplemental Plans

Horizon

NJ DIRECT 1525

Horizon

NJ DIRECT 2030

Horizon

HMO

Horizon

HMO 1525

Horizon

HMO 2030

Retail: Generic Copayments $7 $3 $6 $7 $3

Retail: Preferred Brand Copayments $17 $19 $13 $17 $19

Retail: Non-Preferred Brand Copayments $36 $48 $26 $36 $48

Mail: Generic Copayments $5 $5 $5 $5 $5

Mail: Preferred Brand Copayments $41 $37 $19 $41 $37

Mail: Non-Preferred Brand Copayments $91 $95 $31 $91 $95

Prescription Drug annual Out-of-Pocket Maximum (Individual/ Family)

$1,411/$2,822 $1,411/$2,822 $1,411/$2,822 $1,411/$2,822 $1,411/$2,822

This publication is produced and distributed by the New Jersey Division of Pensions & Benefits (NJDPB) – www.nj.gov/treasury/pensions This is a summary and not intended to provide total information. Although every attempt at accuracy is made, it cannot be guaranteed.

http://www.nj.gov/treasury/pensions

State_Retired_hr1158-combined
Edu_Retiree_hr1162
Edu_Retiree_MA_Med_Sup_hr1164

File details come from the government source that posted it. Updated .