Formulary

If you have prescription drug coverage through Care Choices, your member ID card will include a copayment amount in the lower right-hand corner as follows:

In the box labeled “Copayment,” next to the RX, you will find either two or three numbers. This is the dollar amount you must pay out-of-pocket for your prescription coverage.

View the list of formulary and non-formulary medications. Information on the formulary status of the medication is on the list. Please refer to the legend below when using the list.

Example for the Two-Tier Pharmacy Benefit Plan

Example: RX $5/$15

Tier One
The first number ($5) displays the copayment for generic prescription drugs.

Tier Two
The second number ($15) displays the copayment for preferred brand-name drugs.

Download the Formulary

Example for the Three-Tier Pharmacy Benefit Plan

Example: RX $5/$15/50%

Tier-One
The first number ($5) displays the copayment for generic drug prescriptions.

Tier-Two
The second number ($15) displays the copayment for preferred brand-name drugs.

Tier-Three
The third number (50%) displays the copayment for non-preferred brand-name drugs.

Download the Formulary

If you are still unsure about which pharmacy benefit plan applies to you, please call the Express Scripts Member Help desk at (877) 293-8963 and identify yourself as a Care Choices member. An Express Scripts representative will be happy to assist you.