Prescription Services	Gold EPO	Silver EPO	Bronze EPO
Rx: Retail (30 days)
Tier 1	$5 copay	$5 copay	70% after deductible
Tier 2	$50 copay	$50 copay
Tier 3	$100 copay	$100 copay
Tier 4	$250 copay	$250 copay