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How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These prescription drug lists have different levels of coverage, which are called "tiers". A prescription drug list is a list of drugs available to Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. These drugs are considered to be safe and cost-effective. How much you may pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. These prescription drug lists have different levels of. Publicly funded vaccines. Expensive drugs for rare diseases o n a case-by-case, last-resort basis, that have an approximate annual cost of more than $100,000 per patient. Use the PharmaCare Formulary Search to see which drugs PharmaCare covers. Click on a drug's DIN/PIN/NPN to see the plans it is covered under. 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CCO, Inc. ChoiceCare insurance Network. St. Louis CIGNA Health Plan. This guide has information on prescription drug coverage for Aetna plan participants. Express Scripts administers your prescription drug coverage. THE SERS FORMULARY The SERS Formulary is our prescription plan's list of covered medications. It is made up of generic and brand-name medications that are high quality and cost-effective. Based on your benefits, if you use a drug manufacturer's coupon or copay card to pay for a covered prescription drug, this amount may not apply to your plan deductible or out-of-pocket maximum. Health plans may administer medical and pharmacy coverage separately for select drugs. COST & COVERAGE MOST ADULTS 50 YEARS AND OLDER ARE COVERED FOR SHINGRIX* PRIVATE INSURANCE Patients typically pay no out-of-pocket costs per dose. MEDICARE PART D Majority of patients pay an out-of-pocket cost of less than $50 per dose. *Coverage and cost may vary and are subject to change without notice. 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