Find the Exact Cost of Your Drugs

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

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

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.

Please note that if you are changing from a non-Medicare pharmacy benefit to Medicare Part D, the coverage and requirements for some drugs may change. Check the MedicareRx Plan formulary at Navitus's ETF Benefits website to see how your drugs will be covered.

  Medicare Part D

Prescription Deductible


Prescription Copay / Coinsurance

Level 1 


Up to $5

Level 2 

20% ($50 max)

Level 3 

40% ($150 max)

Level 4 

$50 copay1 (If filled at Lumicera Specialty Pharmacy or UW Specialty Pharmacy.)

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

Individual / Family

$9,450 / $18,900

Level 4 

Individual / Family

$1,200 / $2,400

1Price if you fill at Lumicera Specialty Pharmacy or UW Health Specialty Pharmacies. If you do not fill at one of these pharmacies you will pay 40% ($200 max). The amounts paid will not apply to the Level 4 OOPL, but rather to a federal limit of $8,700 individual / $17,400 family.