Copayment/coinsurance in drug plans

These are the amounts you pay for your covered drugs after the 

deductible [glossary]

 (if the plan has one). You pay your share and your plan pays its share for covered drugs. If you pay  

coinsurance

, these amounts may vary throughout the year due to changes in the drug’s total cost. The amount you pay will also depend on the 

tiers

 level assigned to your drug.

Your plan may raise the copayment or coinsurance you pay for a particular drug when the manufacturer raises their price, or when a plan starts to offer a generic form of a drug, but you keep taking the brand name drug.

Here’s a video about how drug costs can differ by pharmacy.

Once you and your plan spend $4,130 combined on drugs (including deductible) in 2021 ($4,430 in 2022), you’ll pay no more than 25% of the cost for prescription drugs until your out-of-pocket spending is $6,550 in 2021 ($7,050 in 2022) under the standard drug benefit.

note:

The amount you pay for a covered prescription is usually for a one-month supply of a drug. However, you can request less than a one-month supply. You might do this if you’re trying a new medication or you want to synchronize refills for your medications.

If you get less than a one-month supply, the amount you pay is reduced based on the amount you actually get. Talk with your prescriber to get a prescription for less than a one-month supply.

 

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