Individuals & Families
Your prescription benefits and coverage
Confirm your plan covers your medication, and if so, by how much. Find out if there are requirements or limits on coverage, and minimize your out-of-pocket expenses.
Tools to help you save
A guide for Members and providers
We recommend consulting this guide to find out if, and how, your drug is covered, including the tier on which it's covered and if there are any requirements or limits. This can help you minimize out-of-pocket expenses and guide you in the selection of cost-effective drug therapy.
Express Scripts is a leading prescription benefit plan provider throughout the nation. Just as your medical plan covers visits to your doctor, your Express Scripts prescription plan covers your medication. Whether you pick up your prescription at your neighborhood pharmacy or have it delivered, Express Scripts will make sure you get affordable medicine, quickly and conveniently. Their dedicated team of pharmacists, nurses, and patient care advocates delivers personalized care for everyone on your plan.
Sign up for Express Scripts to find a pharmacy near you, review your prescription coverage, receive automatic health and safety alerts, and discover ways you can save. Download our PDF on how to register for this program.
In keeping with our commitment to provide Members with tangible benefits, we've partnered with Rx Savings Solutions to help you and your family save money on prescription medications. This service is a free and confidential benefit for our Members.
Rx Savings Solutions will also work with your physician and local pharmacies to ensure you receive the most affordable medications. Even if you think you are already paying the lowest price available, logging into the Rx Savings Solutions portal will allow you to see if any additional savings exist. Rx Savings Solutions will send you alerts via text or email when you have opportunities to save on your prescription costs.
To learn more about the service or mobile apps, view our Rx Savings FAQ.
Still have questions about your medications? Check out our FAQs
Our drug formulary guides Members and providers in the selection of cost-effective drug therapy. We recommend consulting the formulary to ensure that your prescriptions are covered and your out-of-pocket expenses are as low as they can be.
Popup window is opened
Use the 2019 drug formulary
If you are enrolled in an Individual plan for 2019.
If you enrolled in a plan through your employer with your coverage starting on or after January 1, 2019.
Our drug formulary is a combination of generic, brand, and specialty medications that are selected with the assistance of a team of experts at Express Scripts. News drugs are added to coverage once they reviewed and approved by the Express Scripts Therapeutic Committee. Drugs are only removed from the formulary two times per year (January and July) by Health Options unless deemed unsafe or removed by the Federal Drug Administration (FDA).
Certain medications on our formulary require a prior authorization and are denoted as “PA” in the formulary guidebook. You can locate the prior authorization form here or your provider can contact Express Scripts to initiate the prior authorization process.
Health Options may require you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, we may not cover Drug B unless you try Drug A first. If you try Drug A and it does not work for you, we may then cover Drug B. These medications are denoted as “ST” on the drug formulary guide.
Popup window is opened
Leaving Community Health Options
You are leaving the Community Health Options website and going to Healthcare.gov.
Please note that if you have used our storefront site before and have an existing account (not the same as your Health Options Member account), you must log in to buy a new plan. Or, if you're not ready to buy a plan yet, you can get a quote without logging in.