Understand Your Prescription
Benefit Plan
Based on your health plan, your prescription drug costs may depend on if you’ve met your in-network deductible.
First, you’ll pay your prescription’s full cost upfront until you meet your in-network deductible. After you’ve met your in-network deductible, you’ll pay an out-of-pocket cost of a copay or coinsurance for covered prescription drugs. Your out-of-pocket costs are based on the drug’s payment tier and your plan benefits.
Help with Lowering Your Costs
You may keep your prescription drug costs down if you:
- Fill your prescriptions at an in-network pharmacy
- Ask your doctor if a covered alternative is an option
- Get up to a 90-day supply of covered drugs used regularly1
Remember, pharmacy selections and your care are always between you and your doctor. Ask your doctor if you have questions or concerns about your medications.
How Prescription Tiers Work
Your health plan’s prescription drug list has many levels of coverage, called member payment tiers.
Some plans have up to 4 tiers and some plans have up to 6 tiers. Each tier has its own cost. Most often, the lower the tier, the lower your out-of-pocket costs will be for the drug.
When you get a prescription, you can look up the drug tier on your drug list.
Understanding and Using Your Drug List
After you meet your annual in-network deductible, you’ll pay for your prescription based on its tier on the drug list.
When you look up your prescription drugs, seeing the drug tier lets you know if you’ll pay lower or higher out-of-pocket costs. It can also show you if your prescription drugs have any additional requirements.
Find your medication and learn more about viewing drug costs online:
2024 Individual and Family Health Plans
HMO 6 Tier Drug List
HMO 4 Tier Drug List
Non-HMO 6 Tier Drug List
Non-HMO 4 Tier Drug List
Learn About Additional Requirements
Some drugs listed in the drug list may have additional requirements. This means there may be extra steps to take before getting your prescription filled.
Prior Authorization
In some cases, your doctor will need to send us a pre-approval request before your prescription drug may be covered.
Step Therapy
You may need to first try a more cost-effective drug before some other drug may be covered.
Dispensing Limits
You may only be able to get a certain amount of your drug at one time. Review drug dispensing limits.
Specialty Pharmacy Program
You may need to get a specialty drug at an in-network specialty pharmacy. Some drugs may be filled in a smaller amount (split fill), letting you try them at a prorated cost first. Review specialty pharmacy program details:
More Suggestions For You
1 Not all prescriptions can be filled in a 90-day supply and may need to be filled at select retail pharmacies or via home delivery. Based on your plan benefits, you may not save on your out-of-pocket costs but will spend less time going to the pharmacy.