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Retail
Coinsurance
A coinsurance cost share amount is a percentage of the total prescription
cost.
Implementing coinsurance cost sharing requires a lot of clear and
frequent member communication. However, the approach buffers the employer
from prescription drug cost inflation.
As prescription costs increase, the member pays more. In many cases,
employers may add a dollar minimum and/or a dollar maximum. For example,
a member’s share of the cost of a preferred brand prescription
cost might be 25 percent of the total, with a $3 minimum amount to
be paid for the prescription.
A different employer might not set a minimum. However, it might set
a maximum, so its member would pay 25 percent of the cost of the drug
with a maximum of $150 to be paid.
The 2007 retail coinsurance data are shown in Tables 21 and 22.
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