Patient Cost-Sharing

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Drug benefit plans typically require a patient to pay a certain amount out-of-pocket for their prescription drugs. Cost-sharing options can include copayments, coinsurance, deductibles, or a combination of these. Most drug benefit plans classify drugs on their formularies into groups called “tiers” and establish different levels of cost-sharing for each tier. Lower tiers may have a fixed dollar copayment, but higher tiers increasingly use a percentage of drug cost to determine a patient’s cost share. Since there are often many drugs in a particular class or category of medicines, signaling the cost of specific drugs through patient cost-sharing is an essential tool for keeping drugs affordable.

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Additional Resources

2015 Trend Report

Magellan Rx — Magellan Rx Management is pleased to present the sixth edition of our Medical Pharmacy Trend Report,™ the...

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ACA: Cost Sharing Limits

Cigna — The Patient Protection and Affordable Care Act (PPACA) requires limits for consumer spending on in-network essential health benefits...

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