- Check the Approved Drug List for your plan (also called a "formulary") to make sure the drug you need is listed.
- You can get up to a 31-day supply of any drug on the formulary for one copay.
- Order your prescriptions from a network pharmacy to pay the lowest copays/coinsurance.
What you will pay for prescriptions
Your plan may have a prescription deductible, which is an amount you have to pay for prescriptions before the plan starts to pay. It may also have an out-of-network prescription deductible.
After the costs you pay for prescriptions meets your prescription deductible, you will pay a copayment or coinsurance for your prescriptions (unless you are on an HSA-compatible plan). The amount of your copayment or coinsurance depends on your plan, on whether the pharmacy is in-network or out-of-network, and on the type of drug (see Drug tiers, below).
When you log in to your MyHealth account, you can see your deductible balance (if you have a deductible) and any copayments or coinsurance you'll need to pay.
"Tiers" are simply a way of grouping prescription drugs by cost and purpose. Generic drugs are the least expensive because they are not brand names. It's the difference between buying Kleenex® Tissue and other tissues; some are equivalent to brand-name products in the way they're made, and some just treat the same conditions, but they cost less, so your copay may be lower.
- "Preferred brand" drugs may cost more than a generic, but you'll often pay a lower copayment than for non-preferred brand drugs.
- "Non-preferred brand" drugs are the most costly drugs, so your copayment may be higher with these prescriptions. Ask your provider to prescribe a generic or preferred drug whenever possible.
- "Preferred specialty" drugs are generally self-administered medicines used for a chronic illness. They have special handling requirements or require special training before use.
- "Non-preferred specialty" drugs are more costly than the preferred specialty drugs. Ask your provider to prescribe a preferred specialty drug whenever possible.