A national 501 (c)(3) non-profit charity that provides direct services to patients with chronic, life threatening and debilitating diseases to help access care and treatment recommended by their doctor.
Step 2: See if you have meet your deductible. Your plan will have a deductible, ranging from a few hundred dollars to thousands. Until you have paid an amount in medical costs equal to your deductible, you insurance will not pay for anything.
Our example: Our deductible has been paid in full.
Step 3: Look up your medication in your drug formulary (you can find a copy of your formulary on your plan’s website or you can request one by callings your plan’s number). Take note of the tier your drug is on and if it has any restrictions.
Our example: On our drug formulary, Lisinopril is in Tier 1 and has no restrictions.
Step 4: Find out if your insurance plan requires copay or coinsurance for medication. Copay will have you pay a flat-dollar amount whereas coinsurance will have you pay a percentage of your drug’s cost.
Our example: Our plan uses coinsurance.
Step 5: See how much your plan will have you pay based on what tier your drug falls in.
Our example: Our insurance requires a 40% coinsurance payment for drugs in tier 1.
Step 6: Bust out your calculator to see what your actual cost will be.
Our example: Seeing as how our drug was $58 and our coinsurance was 40% our actual cost will be $23.20 (53 x 0.4 = 23.2).
This process is great when comparing multiple insurance plans. If you know there is a drug that you need, you can quickly estimate the costs between the two plans and make a more informed decision.
With our above example in mind, say an alternate plan had the exact same results except for instead of a coinsurance payment, they asked for a $20 copayment on all tier 1 drugs. Since the $20 copayment would be cheaper than the $23.20 coinsurance payment, it would make sense to choose the other plan.
Keep in mind that the cost of your medications is not the end all factor when it comes to determine the best plan. You need to consider your monthly premium and your deductible as well.