Covered California Silver 87 Rx Benefits
One of the most popular Health Plans, the Covered California Silver 87 plan has no Rx deductible and minimal copays per script.
| You pay… | |
| Individual | No deductible |
| Family | No deductible |
| Tier 1 (generic) Rx Copay | $5 prescription (retail). |
| Tier 2 (preferred brand) Rx Copay | $25 prescription (retail). |
| Tier 3 (non-preferred brand) Rx Copay | $45 prescription (retail). |
| Tier 4 (specialty) Rx Copay | 15% coinsurance up to $150 / prescription. |
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 $3,000 for an individual and $6,000 for families.
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 87 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 pay the $5 copay.
Example 2:
You’re prescribed a Tier 2 (preferred brand) drug that costs $500. You will pay the $25 copay.
Example 3:
You’re prescribed a Tier 4 (specialty) drug that costs $5,000. You will pay 15% of the cost up to a maximum of $150. So, the total you will have to pay for the $5,000 Rx is $150.