Member Services: 1-866-255-4795 | TTY:711
Call to Enroll: 1-833-698-1049 | TTY:711
Top 3 Money-saving Tips
90-day supply:
Many drugs can be filled for a 90-day supply. Save by using Mail Order where you can get 90 days of your drug for the same cost as two-month copay.
Lower tier options:
Picking a similar drug to treat your condition on a lower tier will help save you money. We recommend you bring the formulary with you when visiting your doctor to assist in choosing a lower cost drug.
Generic drugs:
Generic drugs will typically cost you less. Generic drugs are identified on the formulary in italicized.
The following are some condition specific examples.
Glaucoma
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
Tier 1: $0
Tier 2: $12
Tier 3: $47
Tier 4: $100
Tier 5: 33% coinsurance
Tier 6: $0
Other Gluacoma Drugs
Drug Name
Tier
Requirements Limits
brimodnidine-timolol ophthalmic (eye) drops
3
dorzolamide ophthalmic (eye) drops
2
MO
dorzolamide-timolol ophthamlic (eye) drops
2
MO
latanoprost ophthamlic (eye) drops
2
MO
LUMIGAN OPHTHALMIC (EYE) DROPS 0.01%
1
MO, GC
miostat intraocular solution
3
MO
RHOPRESSA OPHTHALMIC (EYE) DROPS
3
MO
ROCKLATAN OPHTHALMIC (EYE) DROPS
3
MO
SIMBRINZA OPHTHALMIC (EYE) DROPS SUSPENSION
3
MO
travoprost ophthalmic (eye) drops
3
MO
Example scenario: Your provider is considering prescribing Rocklatan to treat your glaucoma.
You look at the formulary and find that Rocklatan is on Tier 3, which will cost $47 per month based on the example copays above.
You and your provider see there is another eye drop in the same class on a lower tier:
Latanoprost is on Tier 1. Based on the example copays, it will cost you $0 per month.
This would be a savings of $47 per month or $564 per year.
Skin Conditions
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
Tier 1: $0
Tier 2: $12
Tier 3: $47
Tier 4: $100
Tier 5: 33% coinsurance
Tier 6: $0
Drug Name
Tier
Requirements Limits
ala-cart topical cream 2.5%
2
alclometasone topical cream
3
MO
alclometasone topical ointment
3
MO
betamethasone dipropionate topical cream
2
MO
betamethasone dipropionate topical lotion
2
MO
betamethasone dipropionate topical ointment
2
MO
betamethasone valerate topical cream
2
MO
betamethasone valerate topical ointment
2
MO
betamethasone, augmented topical cream
2
MO
betamethasone, augmented topical gel
2
MO
betamethasone, augmented topical lotion
2
MO
betamethasone, augmented topical ointment
2
MO
clobetasol scalp solution
4
MO; QL (100 per 28 days)
clobetasol topical cream
4
MO; QL (120 per 28 days)
clobetasol topical foam
4
MO; QL (100 per 28 days)
clobetasol topical gel
4
MO; QL (120 per 28 days)
clobetasol topical lotion
4
MO; QL (118 per 28 days)
clobetasol topical ointment
4
MO; QL (120 per 28 days)
clobetasol topical shampoo
4
MO; QL (236 per 28 days)
clobetasol-emollient topical cream
4
MO; QL (120 per 28 days)
Example scenario: Your provider is considering prescribing clobetasol to treat your skin condition.
You look at the formulary and find that clobetasol is on Tier 4, which will cost $100 per month based on the example copays above.
You and your provider see there is another drug in the same class on Tier 2: betamethasone.
Based on the example copays, it will cost you $12 per month.
This would be a savings of $88 per month or $1056 per year.
You look at the formulary and find that Rocklatan is on Tier 3, which will cost $47 per month based on the example copays above.
High Colesterol
Check your summary of benefits to determine the cost you will pay for each tier. For example, a plan may have the following copays:
Tier 1: $0
Tier 2: $12
Tier 3: $47
Tier 4: $100
Tier 5: 33% coinsurance
Tier 6: $0
Drug Name
Tier
Requirements Limits
fluvastatin oral capsule 40 mg
2
MO; QL (60 per 30 days)
genfibrozil oral tablet
1
MO; GC
icosapent ethyl oral capsule
2
MO
JUXTAPID ORAL CAPSULE 10 MG, 20 MG, 30 MG, 5 MG
5
PA; MO; LA; NDS
LIVALO ORAL TABLET
3
ST; MO; QL (30 per 30 days)
lovastatin oral table 10 mg
6
MO; GC; QL (30 per 30 days)
lovastatin oral table 20 mg, 40mg
6
MO; GC; QL (60 per 30 days)
NEXLETOL ORAL TABLET
3
PA; MO
NEXLIZET ORAL TABLET
3
PA; MO
niacin oral tablet 500 mg
2
MO
niacin oral tablet extended release 24 hr
4
MO
omega-3 acid ethyl esters oral capsule
2
MO
pravastatin oral tablet
6
MO; GC; QA (30 per 30 days)
pravastatin oral powder
3
MO
pravastatin oral powder in packet
3
MO
REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR
3
PA; QL (3.5 per 28 days)
REPATHA PUSHTRONEX SUBCUTANEOUS WEARABLE INJECTOR
3
PA; QL (3.5 per 28 days)
REPATHA SUBCUTANEOUS SYRINGE
3
PA; QL (3.5 per 28 days)
REPATHA SURECLICK SUBCUTANEOUS PEN INJECTOR
3
PA; QL; (3.5 per 28 days)
rosuvastatin oral tablet
6
MO; GC; QL (30 per 30 days)
clobetasol-emollient topical cream
6
MO; GC; QL (30 per 30 days)
VASCEPA ORAL CAPSULE 0.5 GRAM
3
MO
Example scenario: You provider is considering prescribing Livalo to treat your high cholesterol. You look at the formulary and find that Livalo is on Tier 3, which will cost $47 per month based on the example copays above.
You and your provider also see there is another drug in the same class on a lower tier:
Rosuvastatin (generic for Crestor) on Tier 6. Based on the example copays, it will cost you $0 per month.
This would be a savings or $47 per month or $564 per year.
P.O. Box 93122 Long Beach, CA 90809
Universal Care, Inc. dba Brand New Day. All Rights Reserved © 2023
