Determine your out of pocket costs
There is not a tool to determine your exact co-pay nor are pharmacies able to run "test claims"; however, you can get an idea or your out of pocket co-pay by following these steps.
1. Go to the drug look up tool and find where your medication falls on the formulary (generic, formulary brand, non-formulary brand).
2. Use the table below.
Co-Pay 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 Advocate can also help you determine your co-pay.
How to Reduce Rx 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 Advocate for assistance in reducing your out-of-pocket expenses.