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Coverage and cost


  • How much money can I save?

    It depends on the plan you choose. When you're looking for a plan, check to see what is included for the price you pay.

    • Some plans have a higher premium, but your deductible may be lower and your plan may pay more of your medical or prescription drug costs.
    • Other plans might have a lower premium, but you may have a higher deductible and pay more for your prescription drugs or doctors' visits.

    Examples:

    Why is the pharmacy benefit important?

    1) Meet Joe

    Joe is a healthy guy. He hardly ever gets sick, so he doesn’t go to the doctor often. Joe's active and likes to ride his bike. One day last spring, Joe hit a pothole and crashed. After visiting the hospital and getting x-rays, Joe learned he broke his arm, and needed surgery to fix it.

    After surgery, Joe's doctor prescribed a medicine to help manage the pain, along with an antibiotic. Joe's prescription drug plan helped save him money:

    Joe's pain medicine*    Total cost $200
      Joe's 25% copay $50
      Joe's plan paid $150
      Joe saved $150
    Joe's antibiotic*    Total cost $300
      Joe's 25% copay $75
      Joe's plan paid $225
      Joe saved $225
      Total saved on both medicines $375


    2) Meet Steve

    Because Joe's prescription drug plan paid for most of the cost of his pain and antibiotic medicines, Joe saved almost $400 on the cost of those two drugs. Joe's prescription drug plan paid for most of the cost of his pain and antibiotic medicines, Joe saved almost $400 on the cost of those two drugs.

    Steve just learned he has diabetes. He's talked with his doctor, and treatment is going well. He's exercising more and watching what he eats. He's already slimmed down.

    To control his condition, Steve has to take medicine every day and check his blood sugar regularly. Thanks to Steve's pharmacy coverage plan, he’s able to get the medicine he needs to stay well. Because Joe's prescription drug plan paid for most of the cost of his pain and antibiotic medicines, Joe saved almost $400 on the cost of those two drugs. Joe's prescription drug plan paid for most of the cost of his pain and antibiotic medicines, Joe saved almost $400 on the cost of those two drugs.

    Steve's diabetes medicine* Per month $100 Cost per year $1,200
      Steve's 25% copay $25 Yearly copay $300
      Steve's plan paid $75 Yearly plan payment $900
      Steve saved $75 Yearly savings $900

     

    Steve could choose to fill the prescription for his diabetes medicine through his plan’s home delivery pharmacy option. Not only can he get a 3-month supply of his medicine mailed straight to his house, he can even get a discount:

    Steve's diabetes medicine* 3-month supply $250 Cost per year $1,000
      Steve's 25% copay $62.50 Yearly copay $250
      Steve's plan paid $187.50 Yearly plan payment $750
      Steve saved $187.50 Yearly savings $750


    *Numbers used here are for illustration only – your actual drug costs might be different, based on the drugs you are prescribed and your plan design.