Deductible: The amount you must pay before the plan starts to pay for your prescriptions.
Coinsurance: After you pay your deductible, you and your plan may share the cost of your prescriptions. The percentage you pay is called coinsurance.
Copay: The out-of-pocket amount you pay the retail pharmacy or the mail order pharmacy for home delivery. You pay one copay per prescription. This fee is most often less than the actual price of the prescription and can vary based on the type of drug and your benefits. Usually, generic drugs have a lower copay than brand-name drugs. If the price of the prescription is less than the copay, then you will pay the lower price.
Tiered Copay: To give quality and affordable drug coverage, most EmblemHealth drug programs have a three-tiered drug formulary benefit. The three tiers, with different levels of coverage are:
Tier 1: Generic Drugs — Generic drugs have the lowest copay.
Tier 2: Formulary or Preferred Brand-Name Drugs — Brand-name drugs have higher copays than generic drugs.
Tier 3: Non-Formulary or Non-Preferred Brand-Name Drugs — These are drugs for which there may be a similar generic drug or preferred brand-name drug on hand. You will pay more for these drugs.
Please note: Some plans include multiple-source generic drugs in Tier 1 and single-source generics in Tier 2.
