Many drugs can be filled for a 90-day supply. Save by using Mail Order where you can get 90 days of your drug for the same cost as two-month copay.
Lower tier options:
Picking a similar drug to treat your condition on a lower tier will help save you money. We recommend you bring the formulary with you when visiting your doctor to assist in choosing a lower cost drug.
Generic drugs:
Generic drugs will typically cost you less. Generic drugs are identified on the formulary in italicized.
Condition-specific examples
Glaucoma
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
- Tier 1: $0
- Tier 2: $12
- Tier 3: $47
- Tier 4: $100
- Tier 5: 33% coinsurance
- Tier 6: $0
| Drug Name |
Drug Tier |
Requirements Limits |
| Other Glaucoma Drugs |
| brimodnidine-timolol ophthalmic (eye) drops |
3 |
|
| dorzolamide ophthalmic (eye) drops |
2 |
MO |
| dorzolamide-timolol ophthamlic (eye) drops |
2 |
MO |
| latanoprost ophthamlic (eye) drops |
2 |
MO |
| LUMIGAN OPHTHALMIC (EYE) DROPS 0.01% |
1 |
MO, GC |
| miostat intraocular solution |
2 |
|
| RHOPRESSA OPHTHALMIC (EYE) DROPS |
3 |
MO |
| ROCKLATAN OPHTHALMIC (EYE) DROPS |
3 |
MO |
| SIMBRINZA OPHTHALMIC (EYE) DROPS SUSPENSION |
4 |
MO |
| travoprost ophthalmic (eye) drops |
3 |
MO |
Example scenario: Your provider is considering prescribing Rocklatan to treat your glaucoma. You look at the formulary and find that Rocklatan is on Tier 3, which will cost $47 per month based on the example copays above.
You and your provider see there is another eye drop in the same class on a lower tier:
Latanoprost is on Tier 1. Based on the example copays, it will cost you $0 per month.
This would be a savings of $47 per month or $564 per year.
Skin Conditions
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
- Tier 1: $0
- Tier 2: $12
- Tier 3: $47
- Tier 4: $100
- Tier 5: 33% coinsurance
- Tier 6: $0
| Drug Name |
Drug Tier |
Requirements Limits |
| ala-cart topical cream 2.5% |
2 |
|
| alclometasone topical cream |
3 |
MO |
| alclometasone topical ointment |
3 |
MO |
| betamethasone dipropionate topical cream |
2 |
MO |
| betamethasone dipropionate topical lotion |
2 |
MO |
| betamethasone dipropionate topical ointment |
2 |
MO |
| betamethasone valerate topical cream |
2 |
MO |
| betamethasone valerate topical lotion |
2 |
MO |
| betamethasone valerate topical ointment |
2 |
MO |
| betamethasone, augmented topical cream |
2 |
MO |
| betamethasone, augmented topical gel |
2 |
MO |
| betamethasone, augmented topical lotion |
2 |
MO |
| betamethasone, augmented topical ointment |
2 |
MO |
| clobetasol scalp solution |
4 |
MO; QL (100 per 28 days) |
| clobetasol topical cream |
4 |
MO; QL (120 per 28 days) |
| clobetasol topical foam |
4 |
MO; QL (100 per 28 days) |
| clobetasol topical gel |
4 |
MO; QL (120 per 28 days) |
| clobetasol topical lotion |
4 |
MO; QL (118 per 28 days) |
| clobetasol topical ointment |
4 |
MO; QL (120 per 28 days) |
| clobetasol topical shampoo |
4 |
MO; QL (236 per 28 days) |
| clobetasol-emollient topical cream |
4 |
MO; QL (120 per 28 days) |
Example scenario: Your provider is considering prescribing clobetasol to treat your skin condition. You look at the formulary and find that clobetasol is on Tier 4, which will cost $100 per month based on the example copays above.
You and your provider see there is another drug in the same class on Tier 2: betamethasone. Based on the example copays, it will cost you $12 per month.
This would be a savings of $88 per month or $1056 per year.
High Cholesterol
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
- Tier 1: $0
- Tier 2: $12
- Tier 3: $47
- Tier 4: $100
- Tier 5: 33% coinsurance
- Tier 6: $0
| Drug Name |
Drug Tier |
Requirements Limits |
| fluvastatin oral capsule 40 mg |
2 |
MO; QL (60 per 30 days) |
| genfibrozil oral tablet |
1 |
MO; GC |
| icosapent ethyl oral capsule |
2 |
MO |
| JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 5 MG |
5 |
PA; MO; LA; NDS |
| LIVALO ORAL TABLET |
3 |
ST; MO; QL (30 per 30 days) |
| lovastatin oral table 10 mg |
6 |
MO; GC; QL (30 per 30 days) |
| lovastatin oral table 20 mg, 40mg |
6 |
MO; GC; QL (60 per 30 days) |
| NEXLETOL ORAL TABLET |
3 |
PA; MO |
| NEXLIZET ORAL TABLET |
3 |
PA; MO |
| niacin oral tablet 500 mg |
2 |
MO |
| niacin oral tablet extended release 24 hr |
4 |
MO |
| omega-3 acid ethyl esters oral capsule |
2 |
MO |
| pravastatin oral tablet |
6 |
MO; GC; QA (30 per 30 days) |
| pravastatin oral powder |
3 |
MO |
| pravastatin oral powder in packet |
3 |
MO |
| REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR |
3 |
PA; QL; (3.5 per 28 days) |
| REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR |
3 |
PA; QL; (3.5 per 28 days) |
| REPATHA SUBCUTANEOUS SYRINGE |
3 |
PA; QL; (3.5 per 28 days) |
| REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR |
3 |
PA; QL; (3.5 per 28 days) |
| rosuvastatin oral tablet |
6 |
MO; GC; QL (30 per 30 days) |
| simvastatin oral tablet |
6 |
MO; GC; QL (30 per 30 days) |
| VASCEPA ORAL CAPSULE 0.5 GRAM |
3 |
MO |
Example scenario: You provider is considering prescribing Livalo to treat your high cholesterol. You look at the formulary and find that Livalo is on Tier 3, which will cost $47 per month based on the example copays above.
You and your provider also see there is another drug in the same class on a lower tier:
Rosuvastatin (generic for Crestor) on Tier 6. Based on the example copays, it will cost you $0 per month.
This would be a savings or $47 per month or $564 per year.