Value Formulary: What You Pay for Your Medicines

  • What You Pay for Your Prescriptions

    With Value Formulary plans you can support your health and may save money too. To do this, CVS/caremark wants you to know what you have to pay for the medicines on your plan. Here’s a short explanation of what you might pay for your prescription medicines.

    Copay: This is the fixed amount that you pay for a covered medicine. Usually you will pay a lower amount for generic medicines than for brand medicines.

    Coinsurance: This is your share of the cost of a covered medicine, calculated as a percent of the medicine’s full cost. For example, if a medicine costs $100 and your plan requires 20% coinsurance, you would pay $20 for the medicine. You might have different coinsurance percentages for generic and brand medicines.

    Minimum: For plans with coinsurance, this is the smallest fixed dollar amount you would pay for a medicine. For example, if a medicine costs $20 and your plan requires 20% coinsurance – but also has a $10 minimum – you would pay $10 for the medicine (instead of $4).

    Maximum: For plans with coinsurance, this is the largest fixed dollar amount you would pay for a medicine. For example, if a medicine costs $1,500 and your plan requires 30% coinsurance – but also has a $300 maximum – you would pay $300 for the medicine (instead of $450).

    Deductible: This is the fixed amount that you must pay each year for prescription medicines before you pay your regular copay/coinsurance and your plan sponsor helps pay for your medicines. For example, if your plan’s prescription deductible is $200 per year, you would pay all of the costs for your medicine until you have paid $200. After that you would pay your regular copay/coinsurance.

    Maximum Out of Pocket: This is the fixed limit that you would pay for your prescription medicines in a year before your plan sponsor pays for all of your prescription medicine costs for the rest of the year. For example, if your plan’s prescription maximum out of pocket is $1,500 per year, you would pay no additional costs for your medicine once your total medicine payments for the year reach $1,500.