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To find out if your prescription is generic, preferred brand (Formulary) or non-preferred brand (Non-Formulary), type in the name of the drug at: Formulary Drug List

In-Drug Store Purchase; after meeting $100 individual/$200 family deductible, for up to a 30-day supply, your cost will be:

Generic: 20% or $10, whichever is greater

Preferred Brand (Formulary): 30% or $20, whichever is greater

Non-Preferred Brand (Non-Formulary): 40% or $30, whichever is greater

Mail Order - No deductible applies; for a 90-day supply, your cost will be:

Generic: $20

Preferred Brand (Formulary): $40

Non-Preferred Brand (Non-Formulary): $60

Mail Order Forms
Go to Ridgeway Pharmacy (Montana)
Go to Pharmacare Mail Order (Pittsburgh, PA)