The amount you pay for prescription drug coverage will depend on what type of prescription you're getting and whether you use retail or mail order. Read on for details and examples on the cost structure.
Cost Structure for Current Plan Year (July 1, 2009–June 30, 2010)
*The cost difference between brand name and generic does not count toward the minimums and maximums.
To make this a little more clear, let's take a look at some examples:
Retail vs. mail order
You're taking a generic medication which costs $40 for a one-month supply. Over the course of a year, you could save $12 by using the mail order program:
- At a retail pharmacy, you'll pay $60 annually ($5 each month x 12 months). Even though 10% of the one-month supply cost is $4, you'll pay $5 each month because of the minimum coinsurance.
- Using the mail order program, you'll pay only $48 annually ($12 every three months x 4 months). A three-month supply costs $120; 10% of that cost is $12 every three months.
Brand name with no generic equivalent
You're taking a brand name medication ($200 for a one-month supply) which has no generic equivalent. Over the course of a year, you could save $320 by using the mail order program:
- At a retail pharmacy, you'll pay $720 annually ($60 each month x 12 months). The monthly cost of $60 = 30% of $200.
- Using the mail order program, you'll pay only $400 annually ($100 every three months x 4 months). A three-month supply costs $600; 20% of that cost is $120 every three months. However, you'll only pay $100 every three months because of the maximum coinsurance.
Brand name with generic equivalent
You're taking a brand name medication ($200 for a one-month supply) which has a generic equivalent ($40 for a one-month supply), and you're using a retail pharmacy. Over the course of a year, you could save $2,100 if you use the generic equivalent:
- If you use the brand name, you'll pay $2,160 annually ($180 each month x 12 months). $180 = $20 (10% of the brand name cost) + $160 (cost difference between brand name and generic). Remember that the $100 maximum coinsurance only applies to the 10% of the brand name cost, not the cost difference between brand name and generic.
- If you use the generic, you'll pay $60 annually ($5 each month x 12 months). Even though 10% of the one-month supply cost is $4, you'll pay $5 each month because of the minimum coinsurance.