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Understanding 2013 Prescription Drug Costs

When determining how to make the most of your coverage, it is important that you know the language and terms, and how they apply to you.

Beginning in 2013, if you enroll in the CareFirst BCBS or EHP Plans, and you purchase formulary and non-formulary brand drugs at a retail pharmacy through Medco/Express Scripts, you’ll pay a coinsurance instead of a copay. You’ll still pay a copay when purchasing generic drugs at a retail pharmacy.

So what is the difference between coinsurance and a copay?
Copay: This is a set amount, determined by the health plan that you pay for the cost of your prescription drugs, regardless of the total retail costs of the drug.
Coinsurance: This is a set percentage, determined by the health plan that you pay for the cost of your prescription drugs. How much you pay will depend on the retail cost of the drug.

Please Note: When purchasing formulary and non-formulary brand drugs, there is a minimum and maximum you will pay out-of-pocket. This means that regardless of the actual percentage of the retail cost of the drug, you will not pay more or less than the costs show below:

Type of Drug Minimum Amount Paid Maximum Amount Paid
Formulary Brand $30 $45
Non-Formulary Brand $30 $45

For Example
Here is an example of how your costs compare under the changes to the CareFirst BCBS and EHP Plans. Let’s use a Lipitor prescription (a formulary brand) as our example. For the purposes of this example, we’ll assume that the cost of a 30-day supply of Liptor is $300. Remember, under the plan, you will not pay more than $45 out-of-pocket for a 30-day retail supply of formulary brand drugs. Take a look at the chart below:

Generic Lipitor (Formulary Brand)
Year 2012 2013 2012 2013
How the Plan Covers the Prescription $10 copay $10 copay $20 copay 20% coinsurance $300 x 20% = $60
Final Cost To You $10 $10 $20 $45*

Save With Generic Drugs
The Food and Drug Administration requires that generic drugs have the same active ingredients and take the same form (for example, pill or liquid) as brand-name drugs, but using generic drugs can save you and JHU money.

Save Time and Money with Mail Order
Mail-order service offers a convenient and cost-effective way to get prescription medications you take on an ongoing basis delivered right to your door. Plus, the cost of mail-order service is less than you would pay for a 90-day supply at a retail pharmacy.

For more information on prescription drug coverage, please see the myChoices tab on the Benefits website.

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