Member Center

A copay (or copayment) is the amount that you are required by your plan to pay when getting a prescription filled. Generally, after you pay your copay, your plan will cover the remainder of the cost of the prescription, if any. Sometimes plans have a deductible for medications or certain types of medications, and these may also have to be satisfied before the plan pays. The copay amount (and deductibles and/or other plan rules) are determined by your plan sponsor's pharmacy benefit. To view the closest estimate of the amount you would pay for a medication, do a drug search from your member dashboard. Remember that drug prices can vary by pharmacy, so feel free to compare!

To find out if your medication is covered, search for the medication from your dashboard in the member portal.

Receiving your medication by mail may save you both time and money. If your plan allows it, when you use a mail order pharmacy, you often pay a smaller copay and, depending upon the medication and your plan rules, you may also be able to get a longer supply. If your plan offers mail service/home delivery, the option will appear when you search for a medication, just like any other available pharmacy. You can compare the cost. And instructions for accessing the mail service will be provided. Note: some plans may require certain long-term medications be transferred to mail delivery after a few courtesy fills at a regular pharmacy. You can reach member services at the number specified on your member benefit card for more information on your plan's rules.

Our contact center is open 24 hours a day, 7 days a week, and is the quickest way to resolve any difficulties or issues you may be experiencing. Call the number on your member benefits card for assistance.

To save the most money on your prescription, consider choosing the generic version of the medication you are prescribed. Generic medications are chemically identical to the brand name medication, but are sold at much lower prices. When you do a drug search in the member portal, our system will show you the possible generic alternatives to the medication you have searched. You can share this search information with your doctor to discuss possible generic alternatives.

We recommend generic alternatives to brand name medications because we want our plan members to save as much money as possible. Generic medications can be up to 80% less expensive than brand name medications.

New drugs have patents that allow the drugs to only be sold by the company holding the patent. Once the patent expires, other manufacturers can apply to the U.S. Food and Drug Administration (FDA) to sell the generic equivalent. The market for generic equivalents is very competitive, which results in lower prices for the consumer.

The FDA requires generic equivalents to have the same active ingredients as the brand-name drug, and to work in the body the same way as the brand-name drug. The FDA requires generic equivalents to have the same quality, strength, purity and stability as brand-name drugs.

For medications that require a prior authorization, your doctor will need to demonstrate that a certain set of criteria have been met in order for the plan to cover the medication. These criteria help to ensure that the prescribed medicine is safe and effective for you to take.

Even though your doctor may prescribe one medicine, treatment guidelines may recommend trying an alternative therapy(ies) first. If the alternative treatment(s) isn't effective, you could then be eligible for the medicine you were originally prescribed.

On a formulary, medications are usually placed into different groups or tiers. These tiers usually include generic, brand-name, and specialty medications. Medications on higher tiers are generally more expensive.

Sometimes a medicine is on the formulary, but your plan will only cover a certain amount of that medicine to be used each day. If requesting more for you than the quantity limit allows, the doctor will need to explain why.

A specialty pharmacy dispenses complex medications for uncommon conditions. Medications may qualify as specialty if they are injected or infused, have a high cost, or require special delivery and storage. When you search for a drug that is a specialty drug, the search tool will specify that for you and instruct you on how to access that medication according to the guidelines of your plan.

The amount a member could owe during a coverage period (usually one year) for prescription services that a plan covers before the prescription insurance begins to pay. The deductible may not apply to all prescriptions.

A member and the benefit share the costs of prescriptions until the total member share for the individual or family out-of-pocket limit is met, whichever is reached first. Once the member spends this amount, the plan will pay the cost of network prescription claims.

This is the maximum allowable amount the plan will pay for prescription claims for a member in the current plan year.

This is the maximum allowable amount the plan will pay for prescription services for a member in all plan years combined.