Your Pharmacy Options

Prescriptions can be filled at any Denver Health Pharmacy (as long as they are written by a Denver Health provider). Denver Health Pharmacies will give you the lowest prescription costs.

Most prescriptions can also be filled at any National Network Pharmacy, such as MedImpact Direct Mail® (serviced by Birdi™ pharmacy), King Soopers, Walgreens, Safeway and most large retail pharmacy chains. The DHMP Pharmacy team can answer your questions at 303-602-2070.

Copay and Coinsurance Defined

Copay: 
The dollar amount that a member is required to pay. The copay will never be higher than the dollar amount listed for that tier in the Member Handbook.

Coinsurance: 
A percentage of the cost of a covered drug that a member is required to pay. The member pays a percentage of the cost and the insurance provider pays the remaining percentage. The coinsurance cost applies to filling at national network pharmacies.

DHHA Employer Plans Pharmacy Copay/Coinsurance Structure for 2025
 

Drug
Tier 

Denver Health 
Pharmacy Costs

Non-Denver Health 
Pharmacy Costs

Preventive

$0

$0

Tier 1 
(Preferred Generics)

$15 for 30 days
$30 for 100 days

$30 for 30 days
$60 for 100 days

Tier 2 
(Preferred Brand)

$25 for 30 days
$50 for 100 days

20% coinsurance

Tier 3 
(Preferred Specialty) 

$60 for 30 days only

25% coinsurance
for 30 days only

Tier 4 
(Non-Preferred) 

$100 for 30 days only

30% coinsurance
for 30 days only


Due to the benefit design changes for 2025, your medication(s) may be placed into a new tier, potentially resulting in a different copay/coinsurance. Please review the 2025 Formulary Tiering Changes or contact DHMP at 303-602-2070.

Copay/coinsurance assistance may be available.

Examples of How Coinsurance and Copay Are Applied

Example A

If Drug A is on Tier 3 and the price of the drug is $500

  • Non-Denver Health Pharmacy Cost: 
    $125 for a 30-day supply
  • Denver Health Cost: 
    $60 for a 30-day supply

(See cost comparison below)

Example B

If Drug B is on Tier 4 and the price the drug is $1,500

  • Non-Denver Health Pharmacy Cost: 
    $450 for a 30-day supply
  • Denver Health Cost: 
    $100 for a 30-day supply

(See cost comparison below)

Cost Comparison

Drug
Name

Tier
Number

Drug
Price

Coinsurance
Non-Denver Health Pharmacies

Copay at
Denver Health Pharmacies

Drug A

Tier 3

$500

$125

$60

Drug B

Tier 4

$1,500

$450

$100

 

Please schedule an appointment with a Denver Health provider to fill the prescription at a Denver Health pharmacy.

Copay/Coinsurance Assistance

DHMP is providing an additional benefit through our Pharmacy Benefit Manager (MedImpact), called MedImpact Assist. This program may help reduce your pharmacy copay or coinsurance at national network pharmacies.

  • Your benefit has been adjusted for select specialty medications where there are manufacturer coupons available. 
  • These coupons assist in keeping the cost down for both you and DHMP. Although your initial copay may be higher, the intent of the coupon program is to lower your copay even further.
  • Some manufacturer coupon programs require the member pay a minimum copay for each fill. This amount will be the member's responsibility and will go toward max out-of-pocket costs.
  • Your pharmacy will proactively enroll you into the manufacturer coupon program for applicable medications. If the manufacturer requests that the member self-enroll in the program, the specialty pharmacy will help you with the process. 
  • When a coupon is available, the average member copay/coinsurance can range from $0 to $25.00 per fill.
  • Most manufacturer coupon programs have an annual maximum. If your copay/coinsurance exceeds the annual maximum or allowed number of refills per year, the standard copay/coinsurance will be applied. 

Many manufacturers provide financial assistance, even if the drug is not included in the MedImpact Assist program. Please visit the drug or manufacturer website for more information. 

Financial assistance may also be available through these organizations: 

Denver Health Foundation Employee Relief Fund
PAN Foundation 
Patient Advocate Foundation Copay Relief 
The Assistance Fund (TAF)