Prescription Drug Lookup
2023 Drug Search - See if your drug is covered
Click here to search the 2023 Shell KelseyCare Advantage Prescription Drug Formulary
2023 Schedule of Copayments for Prescription Drugs
Your pharmacies with preferred cost-sharing include Kelsey Pharmacies, H-E-B, CVS retail pharmacies and CVS Mail Service Pharmacy. If you fill your prescription at these pharmacies, you may pay lower cost sharing than at other pharmacies.
| Preferred Retail and Mail Order Pharmacies |
| Tier |
30-Day Supply |
60-Day Supply |
90-Day Supply |
| 1 |
$0 |
$0 |
$0 |
| 2 |
$0 |
$0 |
$0 |
| 3 |
$40 |
$80 |
$100 |
| 4 |
$80 |
$160 |
$200 |
| 5 |
31% |
31% |
31% |
| 6 |
$0 |
$0 |
$0 |
* Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.
| Standard Retail Pharmacy (Non-Preferred) |
| Tier |
30-Day Supply |
60-Day Supply |
90-Day Supply |
| 1 |
$3 |
$6 |
$9 |
| 2 |
$15 |
$30 |
$45 |
| 3 |
$45 |
$90 |
$135 |
| 4 |
$90 |
$180 |
$270 |
| 5 |
31% |
31% |
31% |
| 6 |
$0 |
$0 |
$0 |
* Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.
If you reside in a long-term care facility, you pay the same as at a retail pharmacy. You may get drugs from an out of network pharmacy but may pay more than you pay at an In-Network pharmacy.
