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). PLEASE NOTE: When prior authorization is required, the drug lookup tool defaults to “No Step Therapy,” as step therapy may be required as part of the prior authorization process.
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 Technician (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. For brand-name medications, members should always check for manufacturer coupons before filling their prescriptions. Search for available savings programs on the drug manufacturers website and sign up to maximize potential savings.
Contact your Pharmacy Technician (see below) for assistance in reducing your out-of-pocket expenses.
