Understanding the Basics of Prescription Drug Coverage

Prescription drug coverage is included in all CoOportunity Health plans. All of the plans we offer use a four-tier formulary called the Enhanced Drug List.

  • “Formulary” is just insurance-speak for a list of prescription drugs that your health plan covers
  • The copay amounts you pay for your covered prescription drug depends on the “tier” or category in which your medication is listed.

How Do Four Tiers Work?

Most CoOportunity Health plans in the individual market, small group (1-50) and mid-market large group (51-100) follow this copayment structure for cost sharing at retail pharmacies for a 31-day supply of covered medications.  In addition, many plans offer first-dollar coverage which means that you do not need to satisfy your deductible before prescription drug coverage is available; all you pay out-of-pocket is the copay amount.

Tier 1 Tier 2 Tier 3 Tier 4
Generic Formulary Drugs Formulary Preferred Brand-Name Drugs Non-Formulary Brand-Name Drugs Specialty Drugs
$10 copay $40 copay $80 copay $150 copay

It is important to understand the prescription drug coverage before you select a plan and enroll. Some plans in the individual market (catastrophic, bronze) and many HDHP/HSA plans in individual and group have different copay amounts and some require that you meet you plan deductible before prescription drug benefits pay.

Please refer to the Shop for Insurance section of the website if you are evaluating plans.

Enrolled members should refer to the Individual Policy/Benefits Certificate and specific information on Pharmacy Plan Details: log on to access your specific plan information.

Three Advantages of Pharmacy Network Services
66,000 Network Pharmacies

MedImpact is our pharmacy benefits manager (PBM). MedImpact contracts with more than 66,000 pharmacies across the United States. You can search for a pharmacy by name, city, state, zip or specified travel radius.

Mail Order Saves Time & Money

Looking to save a copayment and have the convenience of home delivery? Our mail order service, HealthPartners myMailRx, is an easy way to save money for drugs you take on an ongoing basis.

Specialty Drug for Complex Conditions

Specialty drugs are high-cost drugs used to treat complex or rare conditions. These drugs usually require a higher degree of management and typically are not stocked at retail pharmacies.



Quick Tools: Pharmacy

LOG ON to use these tools

Safe Disposal of Medicines

An estimated 250 million pounds of unused medicines are improperly disposed of each year, threatening our ecosystems and overall health.* Improper disposal also increases the risk of accidental poisoning and drug abuse. Learn how to protect yourself, friends and family from prescription drug abuse at

Get rid of your medicines safely in one of the following ways:

In Iowa – TakeAway – a drug disposal program with The Iowa Pharmacy Association

In Nebraska – Nebraska MEDS (Medication Education and Disposal Strategies) Program

*According to Sharps Compliance, a national medicine take-back company