Pharmacy (Rx) Copayments Generic Drugs Formulary Drugs $10 $35 Plan Type Average PPO Plan Non-Formulary Specialty Drugs Copayments $75 $250 Did you know? In Indiana, 74% of employees enroll in HDHPs, while only 22.4% of employees choose Physician Care Copayments PPO plans. Primary Care Specialty Care $25 $50