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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


How Much Do I Pay for Prescriptions?

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Question: How do I find out how much my prescriptions are going to cost?

Answer: Each health insurance company has a drug formulary posted on their website. No matter which health plan you choose, the drugs will be labeled as Tier 1 (generic drugs), Tier 2 (preferred drugs), Tier 3 (non-preferred drugs) or Tier 4 (specialty drugs). Your cost for your prescriptions will be lowest for Tier 1, and highest for Tier 4. Each carrier must provide current and prospective members with an estimate of the out-of-pocket cost for specific drugs. In 2017, California insurance carriers cannot charge more than $250 per month for one 30-day supply for Silver 70, Gold 80 and Platinum 90 plan members and no more than $500 per 30-day supply for Bronze 60 plan members. These costs apply to Tier 4 (specialty drugs). Drugs in lower tiers have lower costs.

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