Prescription Deductible

The amount of money that you pay out of your pocket before the insurance company begins to pay. A prescription deductible is the portion you’d pay first, then after you’ve paid the deductible, you may only have to pay a copay after that when you pick up your medication. If you are single, you would only have to meet your prescription deductible. If you have two or more people in your family, each member may have to meet their own prescription deductible. Usually, the insurance company will have two deductibles per family, but you must read the summary of benefits first to find that out.

A prescription deductible is different and separate from the medical deductible. They are separate deductibles. One deductible is for hospitalization etc., and one for filling your prescriptions.

The prescription deductible may only apply to certain “Tiers” on your insurance company’s “Formulary”, (the list of drugs on your insurance plan the insurance company covers). So based on what “Tier” your prescription drug is, may determine if you start paying for it with just a copay, or if you have to pay the deductible first, then copays. Some health insurance company’s may put a deductible on Tier 3 and Tier 4 medication, but not Tier 1 or Tier 2 medication. Some insurance companies don’t put a prescription deductible on any of their plans.

It’s important to look for your medication in the formulary, find out what Tier it is, then look to see if there is a deductible for that Tier. This is important to do before you buy your health insurance plan. You must look at your own individual policy.