Determine your out of pocket costs
No tool can definitively determine your exact copay, nor are pharmacies able to run "test claims"; however, you can get an idea of your expected out-of-pocket copay by following these steps:
1. Go to the Prescription Drug Lookup Tool and find where your medication falls on the formulary (generic, formulary brand, non-formulary brand).
2. Use the table below.
Copay Structure Table
| Type of Medication |
Retail Network or Mail Order (90-day supply) |
| Generic Medication |
$10 for 1-30 days $20 for 31-60 days $30 for 61-90 days |
| Formulary Brand Medication | $15 or 25% of drug cost, whichever is greater |
| Non-Formulary Brand Medication | $40 or 45% of drug cost, whichever is greater |
Your Pharmacy Benefits Specialist (see below) can also help you determine your copay.
How to Reduce Prescription Expenses
1. Generic medications will generally cost you less than Preferred and Non-Preferred brand medications. Always ask your physician whether a generic medication can be ordered.
2. If the generic medication isn't available, ask if a medication from the Preferred Drug List will work for you. You can use this Preferred Drug Lookup Tool to find preferred medications.
3. Tablet splitting may also offer some additional savings.
Contact your Pharmacy Benefits Specialist (see below) for assistance in reducing your out-of-pocket expenses.
