Skip to main content

Care tools

Find out whether your drug is covered.

Enter the prescription and your plan type. We will point you at the formulary that decides your price, and explain what to do if the drug is not on it.

Start here

Look up a prescription.

Nothing you type is stored or sent anywhere. Your answers decide which drug list we send you to.

Drug search

Use the name printed on the bottle or the prescription. If you know the generic name, use that: formularies are organized by generic name, with the brand listed alongside.

Brand or generic name, with the strength if you know it.

Drug lists are set per plan, so this decides where to look.

Plans and pharmacy networks are county by county.

We do not store what you type here. Nothing is sent anywhere until you choose a link below.

How drug lists work

Tiers, not prices, are what a formulary publishes.

Most plans sort covered drugs into four or five tiers. The tier sets your share, so the same prescription can cost very different amounts under two plans that both cover it.

  • Tier 1

    Preferred generics

    The lowest copay on most plans. Chemically the same active ingredient as the brand, and for most conditions the first thing a plan expects you to try.

  • Tier 2

    Generics and preferred brands

    Non-preferred generics and the brand drugs the plan negotiated a better price on. A moderate copay, often a flat dollar amount.

  • Tier 3

    Non-preferred brands

    Brand drugs with a generic or preferred alternative available. Usually a higher copay, and sometimes coinsurance instead of a flat amount.

  • Tier 4

    Specialty drugs

    High-cost drugs for complex conditions, often injected or infused. Typically coinsurance rather than a copay, and frequently limited to a specialty pharmacy.

When a drug is not covered

A no from the pharmacy counter is rarely the last word.

Being told a prescription is not covered usually means one of three things: the drug is not on the formulary at all, it is on the list but needs prior authorization, or the plan wants you to try something else first. Each of those has a path forward, and your prescriber’s office deals with them every week. Start by asking what specifically was denied, because the fix for a missing prior authorization is very different from the fix for a drug that was removed from the list.
Read the pharmacy coverage guideHow to appeal a coverage decision
  • Ask your prescriber whether a covered generic or a preferred brand on the list would work for you
  • Ask whether the plan will approve it with prior authorization, which is a coverage review before the pharmacy can fill it
  • Check whether step therapy applies, meaning the plan wants you to try a lower-tier drug first
  • Request a formulary exception in writing if there is a medical reason the alternatives will not work
  • If the exception is denied, use the plan appeal process, and then the external review program
  • Compare the cash price at more than one pharmacy: for some generics it is lower than a copay

Good to know

Questions about prescription coverage.

Why does this page not tell me my copay?
A copay depends on your specific plan, its formulary, which tier the drug sits in this year, whether you have met your deductible, and which pharmacy fills it. None of that is knowable from a drug name alone, and a number we invented would be worse than no number. The formulary attached to your member ID has the real answer, and this page shows you how to reach it.
What is a formulary?
A formulary is the list of prescription drugs a plan covers, organized into tiers that set what you pay. Plans update it during the year: drugs move tiers, generics get added when they come to market, and drugs are occasionally removed. Insurers have to tell you before a change affects a drug you are taking, but it is worth checking the list at renewal.
What are prior authorization and step therapy?
Prior authorization means the plan reviews the prescription before it will pay, usually to confirm the drug is being used for an approved condition. Step therapy means the plan expects you to try a lower-cost drug first and move up only if it does not work. Both are decided by the plan, not the pharmacy, and both can be appealed with support from your prescriber.
Is the generic really the same as the brand?
A generic approved by the Food and Drug Administration has the same active ingredient, strength, dosage form, and route of administration as the brand, and has to meet the same standards for quality and performance. Inactive ingredients such as fillers and dyes can differ, which matters for a small number of people with allergies or sensitivities. Ask your prescriber if you have a reason to think that applies to you.
I take several prescriptions. How do I pick a plan around them?
Make a list of every drug with its exact name and dose, then check that list against the formulary of each plan you are considering before you enroll, not after. For Medicare, the official Plan Finder does this comparison for you and estimates your yearly drug cost under each plan. For marketplace plans, open each plan listing and search its drug list.
Browse all insurance FAQs

Compare before you enroll

Check your prescriptions against a plan, not after.

Enter your ZIP code to see the plans sold in your county, then check each drug list for the prescriptions you take.

Compare plans available in your area in minutes.