Here are a few examples of how the two "cost-sharing" options could compare:
- Example 1. Advair Diskus: may have a retail cost of $270
- Co-Insurance (20%) - you pay $54
- Co-Insurance (48%) - you pay $130
- Co-Payment (Preferred Brand-Name Tier) - you pay $23 to $47 (depending on the plan)
- Example 2. Cellcept: may have a retail cost of $1,300
- Co-Insurance (25%) - you pay $325
- Co-Insurance (Preferred Brand-Name Tier) (16%) - you pay $208 (depending on the plan)
- Example 3. Premarin: may have a retail cost of $130
- Co-Insurance (35%) - you pay $46
- Co-Payment (Preferred Brand-Name Tier) - you pay $42 to $95 (depending on the plan)
- Example 4. Januvia: may have a retail cost of $370
- Co-Insurance (20%) - you pay $74
- Co-Payment (Generic Tier) - you pay $22 to $47 (depending on the plan)
Where can I find an approximation of retail prescription drug cost?
Both our Formulary
Browser (showing all drugs for a single Medicare plan) and our Drug
Finder (www.Q1Rx.com - showing all Medicare plans covering a single drug) display the average retail cost for medications, details of the drug utilization management restrictions, and with the drug
cost-sharing information for all Medicare Part D plans and Medicare Advantage plans that include drug coverage.
As can be seen by these cost-sharing examples above, although the retail price may vary, the Co-Payment for this class or tier of medication remains the same and the Co-Insurance figure fluctuates as a percentage of the retail price - meaning your drug costs will fluctuate throughput the plan year as the retail drug price changes.
Therefore, the most affordable alternative between Co-Payment and Co-Insurance plans will depend on the retail costs of medication that you are using and the placement of those medications within the tiers of a plan's formulary.
Please note that we show the historical retail price trends in our Drug Finder (Q1Rx.com)
- just click on the retail price link
. This means, you can see how the price for this medication has changed over the years
and this may give you an idea of whether (historically) co-insurance is a riskier alternative as compared to a Medicare Part D plan that offers a fixed co-payment as a cost-sharing alternative.