Based on your health care plan, what you pay for your prescription drugs depends 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 a copay or coinsurance for covered prescription drugs. Your out-of-pocket costs are based on the drug’s payment level tier and your plan benefits.
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.
Your health plan’s prescription drug list has many levels of coverage, called payment level tiers.
Your pharmacy benefit has up to 6 payment level 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 tier level on your drug list.
After you meet your annual in-network deductible, you’ll pay for your prescription based on its payment level 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 it has any special requirements.
Find your medication on your drug list:
Some drugs listed in the drug list may have special requirements. This means there may be extra steps to take before getting your prescription filled.
In some cases, your doctor will need to send us a pre-approval request before your prescription drug may be covered.
You may need to first try a more cost-effective drug before some other drug may be covered.
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.