DeductibleĪs the year goes on and you spend money on healthcare the amount that comes out of your pocket gets added up so that when you reach your deductible amount the insurance will kick in and start to pay. This allows the PBM to know how much money the patient has actually paid for the medication. To be able to use these copay programs, pharmacies must run a second request to the PBM in order to get the copay amount lowered so the pharmacy can get paid by the pharmacy manufacturer who sponsors the copay coupon. The PBM then tells the pharmacy how much the patients owes and how much the insurance will pay. When the pharmacy bills for the medication they are sending a request for payment to the PBM. The accumulator part comes in thanks to the PBM who is keeping track of all the claims made for medications. These programs can end up paying thousands of dollars per year toward expensive brand name drugs. ![]() Here are a few examples of drug copay coupons for popular drugs: ![]() These copay assistance programs as they are called, help pay for some or all of the patients copay. In the case of branded drugs, many will offer copay coupon cards. For a one hundred dollar medication with 70/30 coinsurance would look like this:ĭepending on your insurance, the pharmacy will tell you an amount owed. Common coinsurance splits are 70-80% insurance, 20-30% patient. Typically, after you have paid some amount out of pocket the insurance will split the remaining amount with you. ![]() Coinsurance, or portion that you pay while the insurance is also paying a portion.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |