How the formulary works
To view the list of covered medications; how to read your prescription drug formulary
Below is a brief overview of how to use the formulary; for a deeper dive, see “How to read your prescription drug formulary.” It’s a good idea to make a list of your drugs and compare it to the formulary when choosing your medical plan. Then, consider how the copay or deductible plus coinsurance models described above will impact your share of the cost.
For the Signature Plan, one way the prescription drug formulary classifies medications is by cost tier – usually 1, 2, or 3 – to indicate whether a medication is generic, preferred brand or nonpreferred brand.
- Generic medications (Tier 1) are the most cost-effective option for many prescriptions. Generic drugs must work in the same way and provide the same clinical benefit as their brand-name counterparts to be approved by the Food and Drug Administration (FDA).
- Preferred brand medications (Tier 2) are brand-name medications that are favored over other brand-name medications on the formulary. Choosing a preferred brand when a generic is available will result in higher cost. You may want to talk to your provider to determine if switching to a generic medication can save you money.
- Nonpreferred brand medications (Tier 3) are the highest-cost option for covered prescriptions on the formulary. Choosing a nonpreferred brand when a generic or preferred brand is available will result in higher cost. You may want to talk to your provider to determine if switching to a generic or preferred brand medication can save you money.
With the Signature Plan, both medication type and cost tier will affect the amount of your copay. For example, a 30-day supply of a generic, tier 1 maintenance prescription would be a $5 copay while a 30-day supply of a generic, tier 1 specialty prescription would be a $20 copay.
With the HSA Advantage Plan, the percentage of coinsurance doesn’t change based on medication type or cost tier but does change based on where you fill your prescription.
- For example, an antibiotic at the health system pharmacy will be a 10% coinsurance after you have met your deductible, but that same antibiotic will be a 30% coinsurance at an in-network pharmacy such as Walgreens or Walmart.
In addition, there can be a big difference in the overall cost of the drug based on whether you choose lower-cost generics or higher-cost brand-name drugs, which will make the amount of your coinsurance higher.
Learn more about cost tiers and special codes in our guide on how to read your prescription drug formulary.