Confused about prescription drug coverage

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If a drug is “covered“ (using the website filter) just how covered are we talking about? I assume it doesn’t mean it’s free from the get go.

I take a prescription medication that costs $400 a month without insurance. It’s Tier 3. From reading the plan document below, it looks like I would pay 50% of the cost ($200) until I hit the $950 out-of-pocket-maximum. Do I understand that right?

(Why I’m asking: The same insurance co offers identical plans except with higher deductables/out of pocket maximum. If I understand correctly – I’ll “need” that lower out of pocket maximum. If I‘m wrong though, I can pick a cheaper plan with a higher deductables/out of pocket maximum.)

https://sbc.deancare.com/api/GetPdf/Dean_Dean%20Focus%20Network%20Silver%20Value%20Copay%205000X06_0121.PDF/true

submitted by /u/Czilla9000
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If a drug is “covered“ (using the website filter) just how covered are we talking about? I assume it doesn’t mean it’s free from the get go. I take a prescription medication that costs $400 a month without insurance. It’s Tier 3. From reading the plan document below, it looks like I would pay 50% of the cost ($200) until I hit the $950 out-of-pocket-maximum. Do I understand that right? (Why I’m asking: The same insurance co offers identical plans except with higher deductables/out of pocket maximum. If I understand correctly – I’ll “need” that lower out of pocket maximum. If I‘m wrong though, I can pick a cheaper plan with a higher deductables/out of pocket maximum.) https://sbc.deancare.com/api/GetPdf/Dean_Dean%20Focus%20Network%20Silver%20Value%20Copay%205000X06_0121.PDF/true
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