Find the Exact Cost of Your Drugs

Find out the cost of a medication before you get to pharmacy by using the Drug Cost Preview tool:

  1. Go to Navitus ETF Benefits website.
  2. Select your health plan design.
  3. Select Drug Cost Preview.

Breakdown of Your Pharmacy Costs

Each covered prescription drug falls into one of four cost-sharing levels. The lower the level, the less you pay. The table below shows how much you will pay for drugs in each level and the maximum amount you will pay for covered drugs each year.

You must fill your prescriptions at an in-network pharmacy. Find an in-network pharmacy. In-network pharmacies are available nationwide. 

  IYC Local Health Plan

Prescription Deductible


Prescription Copay/Coinsurance

Level 1 


$5 or less

Level 2 

20% ($50 max)

Level 3 

40% ($150 max)1

Level 3 “Dispense as Written” or “DAW-1” drugs may cost more. 

Level 4 

$50 copay2

Must fill at Lumicera Health Services specialty pharmacy or UW Specialty Pharmacies.

Preventive prescription copay

$0 - Plan pays 100%, regardless of deductible, as federally required

Prescription Out-Of-Pocket Limit

Levels 1 & 2 

Individual / Family


$600 / $1,200

Level 3 & 4

Individual / Family

$9,450 / $18,900

1 For Level 3 “Dispense as Written” or “DAW-1” drugs, your doctor must submit a one-time FDA MedWatch form to Navitus. If there is no form on file with Navitus, you will pay more. Contact Navitus for details.

2 Must fill at Lumicera Health Services specialty pharmacy or UW Health Specialty Pharmacies.