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  • Retail Pharmacy Prescription Drug Costs

    Tier 1 Tier 2* Tier 3*

    $15 for up to 30-day supply
    (non-maintenance medication)

    $20 for up to 30-day supply
    (maintenance medication)

    $35 for up to 30-day supply
    (non-maintenance medication)

    $45 for up to 30-day supply
    (maintenance medication)

    $60 for up to 30-day supply
    (non-maintenance medication)

    $75 for up to 30-day supply
    (maintenance medication)

    *Cost is based on if a generic is not available. If a generic is available and you chose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

     

  • All Carrier Mail Order/HealthSelect Prescription Drug Program EDS* Costs

    *These costs also apply when using the HealthSelect Prescription Drug and HealthSelect Medicare Rx Extended Days Supply (EDS) Pharmacy Network.

     

    Tier 1 Tier 2* Tier 3*

    $30 for 31-60 day supply

    $45 for 61-90 day supply

    $70 for 31-60 day supply
    (generic not available)

    $105 for 61-90 day supply
    (generic not available)

    $120 for 31-60 day supply
    (generic not available)

    $180 for 61-90 day supply
    (generic not available)

     

    *If a generic is available and you choose to buy the brand-name drug, you will pay the generic copay plus the cost difference between the brand-name and the generic drug.

    If you are enrolled in Community First Health Plan or Scott & White Health Plan, you can find more information about your mail order services and formulary drug list at the links and phone numbers provided below.