1. California Health Insurance
  2. Covered California
  3. Rx Benefits
  4. Silver 73

Covered California Silver 73 Rx Benefits

One of the most popular Health Plans, the Covered California Silver 73 plan has no Rx deductible and minimal copays per script.

You pay…
Individual No Rx deductible
Family No Rx deductible
Tier 1 (generic) Rx Copay $15 not subject to Rx deductible
Tier 2 (preferred brand) Rx Copay $55 after Rx deductible
Tier 3 (non-preferred brand) Rx Copay $85 after Rx deductible
Tier 4 (specialty) Rx Copay 20% up to $250 per script
Rx Maximum

If you take multiple medications, expensive medications or you experience a year in which you need a lot of prescriptions the most you will pay for anything in a year (prescription drug costs included) is the out-of-pocket maximum which is $6,100 for an individual and $12,200 for families.

What does “per script” mean?

Coverage is generally calculated per script or each time the prescription is filled for up to (but not exceeding) a 30 day supply of the drug. For a 1-30 day supply the “per script” cost would have to be met once. For a 31-60 day supply the “per script” cost would have to be met twice. For 61-90, three times. Etc.

In the case of the Silver 73 plan, only Tier 4 (specialty) drugs are subject to the “per script” rule.

Example 1:

You’re prescribed a Tier 1(generic) drug by your Doctor that costs $100. You will only pay the $15 copay.

Example 2:

You’re prescribed a Tier 2 (preferred brand) drug that costs $500. You will pay the $55 copay.

Example 3:

You’re prescribed a Tier 4 (specialty) drug that costs $5,000. You will pay 20% of the cost up to a maximum of $250. So, the total you will have to pay for the $5,000 Rx is only $250.