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
Finder (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 copayment for this class or tier of medication remains the same
and the coinsurance 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 copayment and coinsurance 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) coinsurance is a riskier alternative as compared to a Medicare Part D plan that offers a fixed copayment as a cost-sharing alternative.