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Drug Formulary Proposal & Comparison PDF Print E-mail
Nov 17, 2005 at 04:52 PM
Please!! We Need Your Feedback On This!

We are concerned that the new expensive Tier 4 contains many drugs that are used primarily by retirees for arthritis. Please review the new 2006 lists to see if your important prescriptions are scheduled to move into a more expensive category. If so, please use the link below to e-mail us your concerns, and how the changes will affect you.

Attached are the 2005 and proposed 2006 drug formularies from Delta's health plan for non-pilot retirees who are not PAFCA union members (or who otherwise elect to be covered by the non-pilot plan). There is a new Tier 4 for certain medications which is much more expensive. Please see the following charts to understand how the proposed Delta changes would affect your prescription costs:

Please click on the Following two Items to Retreive the Formulary and the Read More Link to See the Price Tables

2005 Formulary
Proposed 2006 Formulary
Adobe Reader Required to View
Click on the Icon to Download and Install


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Prescription Cost Comparison

Co-Pay Cost at pharmacy
. 2005 Enhanced 2005 Standard 2006
Tier 1 $10 $10 $10
Tier 2 $25 $30 $30
Tier 3 $40 $55 $50
Teir 4 (New) . . $70


Co-Pay Cost for mail order (up to 90 day supply)
. 2005 Enhanced 2005 Standard 2006
Teir 1 $25 $25 $25
Teir 2 $60 $70 $70
Teir 3 $100 $135 $125
Teir 4 (New) . . $175


Please click on the Following two Items to Retreive the Formulary
2005 Formulary
Proposed 2006 Formulary
Adobe Reader Required to View
Click on the Icon to Download and Install


Send comments to:
Last Updated ( Sep 18, 2006 at 11:38 AM )
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