How the formulary works
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How to read your prescription drug formulary
The medications covered are the same in both the HSA Advantage and Signature plans.
Here 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 deductibles, copays, coinsurance and out-of-pocket maximums will impact your share of the cost.
For the Signature Plan, one way the prescription drug formulary classifies medications is by cost tier. In 2025, there will be four tiers in the formulary for our medical plans, up from three. The higher the tier number, the higher the cost of the medications in it. Because of rising costs, some medications and products will move to the new tier 4. These may include treatments for migraines, continuous glucose monitors and disposable insulin pumps, among others.
To help manage your prescription costs, always ask your provider for a medication in tier 1, if available, for the lowest cost.
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 tier 1 maintenance prescription would be a $5 copay while a 30-day supply of a 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.