Prescription Co-Pay Structure

Carelon Rx

Member Services: 833-439-1004

Pharmacy Help Desk: 833-296-5039

Specialty Pharmacy: 833-255-0645

Retail Pharmacy - 31-Day Supply

Present your medical I.D. card with your prescription. The pharmacist will fill your prescription and submit your claim electronically for you. You will be charged a copay based on the following criteria:

Generic - $5

Preferred Brand - 25% to a maximum of $35

Non-Preferred Brand - 45% to a maximum of $70

A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at Ingenio.

Retail Pharmacy - 90-Day Supply

Generic - $10

Preferred Brand - $50

Non-Preferred Brand - $90

When the retail cost of a Preferred or Non-Preferred Brand name drug is more than $67.00, you can save money using the Retail 90-day supply program.

This program was designed for individuals using maintenance medications for long-term medical conditions.

Have your doctor write your prescription for a 90-day supply with three refills, if appropriate. A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at Ingenio.

Mail Order Pharmacy - 90-Day Supply

Generic - $10

Preferred Brand - $50

Non-Preferred Brand - $90

When the retail cost of a Preferred or Non-Preferred Brand name drug is more than $67.00, you can save money using the mail order pharmacy.

This program was designed for individuals using maintenance medications for long-term medical conditions.

Have your doctor write your prescription for a 90-day supply with three refills, if appropriate.
Complete the Order Form and Patient Profile questionnaire. The questionnaire will only need to be completed with your first order.
Select method of payment, i.e., credit card or check. Online ordering is available after your initial order.

A covered person may elect a brand name product when a generic is available; however, the covered person will be liable for the difference in cost between the brand name and the generic drug along with the brand name copay.

A generic or formulary drug will automatically be substituted for a brand name drug unless there are health reasons and a letter of medical necessity from the prescribing physician has been received and approved by a panel of clinical pharmacists at Carelon Rx.