Qualified Health Plan drug costs

The drug formulary is more than just a list of medications. It can also help you figure out what your cost (or copay) for a medication will be and whether there is a lower cost option. Select your plan below to search the formulary.

When searching for a drug, pay attention to the drug tier listed next to it. Then find your plan type below to see the cost for that drug tier. If no tier is listed, there may be a restriction on that particular drug, and you may need to try another medication first. In some cases, your doctor needs to ask us for approval to prescribe you a medication before we can cover it.

Retail prescriptions (1-month supply)

Plan Name Tier 1
Generic Drugs		 Tier 2
Preferred Brand Drugs		 Tier 3
Non-Preferred Brand
and Specialty Drugs
Platinum $10 $25 $50
Gold $30 $60 $90
Low Gold $30 $60 after deductible $90 after deductible
Silver A $30 $60 after deductible $90 after deductible
Silver A II $30 $60 after deductible $90 after deductible
Silver B $30 after deductible 35% after deductible 35% after deductible
Bronze $30 after deductible $120 after deductible $200 after deductible

Mail-order prescriptions (3-month supply)

Plan Name Tier 1
Generic Drugs		 Tier 2
Preferred Brand Drugs		 Tier 3
Non-Preferred Brand
and Specialty Drugs
Platinum $20 $50 $150
Gold $60 $120 $270
Low Gold $60 $120 after deductible $270 after deductible
Silver A $60 $120 after deductible $270 after deductible
Silver A II $60 $120 after deductible $270 after deductible
Silver B $60 after deductible 35% after deductible 35% after deductible
Bronze $60 after deductible $240 after deductible $600 after deductible

ConnectorCare and Qualified Health Plan members may be exempt from paying a copay for the following reasons:

  • The member is receiving family planning supplies and/or family planning services.
  • The member has met the annual out-of-pocket maximum when applicable.
Glossary

Generics - You will pay the lowest copay for generic drugs. Generics are equivalent to their brand-name counterparts, and are ensured by the Food and Drug Administration to be as safe and effective.

Preferred Drug - These are drugs covered by your pharmacy benefit when generic equivalents are not available.

Non-Preferred Drug - These are brand-name drugs that are not covered under your pharmacy benefit but may be covered if they are a part of your medical benefit, another preferred drug is tried first, or prior approval is obtained