City of Colorado Springs Prescription Drug Benefit

County - City Pharmacy Co-pay
DRUG 30-Day Supply* 90-Day Supply** Diabetic Supplies (90-day Maximum)
First Tier: $5.00 $12.50 $0.00
Second Tier: $25.00 $50.00 $0.00
Third Tier: $45.00 $90.00 $0.00
* Lesser of 30-day supply or 200 units
** Lesser of 90-day supply or 600 units


Fourth Tier (Restricted to IV Solutions)
30-Day Supply 90-Day Supply
$60.00 $150.00


Network Pharmacy
DRUG Non-Maintenance Fill* Maintenance First Fill Maintenance Second Fill Maintenance Third & Subsequent Fills Diabetic Supplies
First Tier: $15.00 $15.00 $30.00 100% of Retail Cost Same as Retail Network Co-pay
Second Tier: $40.00 $40.00 $80.00 100% of Retail Cost Same as Retail Network Co-pay
Third Tier: $65.00 $65.00 $130.00 100% of Retail Cost Same as Retail Network Co-pay

* Non-Maintenance Medications fall into the following classes:

  • Analgesics (Narcotic and non-narcotic pain medications)
  • Antiinfectives (oral, opthalmic, otic, topical)
  • Antidiarrheals
  • Antidotes
  • Antinauseants
  • Bronchodilators
  • Cough & Cold Preparations
  • Muscle Relaxants
  • Steroids (excludes inhalers)

Preferred Drug List (PDF)

Preferred Alternatives List (PDF)


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