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.
You may keep your prescription drug costs down if you:
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 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.
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.
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.
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.
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.
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.