Pharmacy Benefit states: Maximum: $20,000 maximum payable per individual, per calendar year for combined retail and mail order. Out-of-Pocket Maximum for Contracting Pharmacy only $3,000 per person up to $6,000 per family, per calendar year. Maximum does not apply to prescription drugs that are excluded by the Plan and penalties for non-compliance with the Plan’s Utilization Review Program.
The PBM rep couldn’t explain this to me. There are copays of $20/$30 for generic and brand name prescriptions. My parent hit their max for the year in September and has paid cash for all prescriptions since then with a total of $4000. Does the $3000 oop max pertain to copays before max benefit is hit?
submitted by /u/Lucyloufro
[link] [comments]Pharmacy Benefit states: Maximum: $20,000 maximum payable per individual, per calendar year for combined retail and mail order. Out-of-Pocket Maximum for Contracting Pharmacy only $3,000 per person up to $6,000 per family, per calendar year. Maximum does not apply to prescription drugs that are excluded by the Plan and penalties for non-compliance with the Plan’s Utilization Review Program. The PBM rep couldn’t explain this to me. There are copays of $20/$30 for generic and brand name prescriptions. My parent hit their max for the year in September and has paid cash for all prescriptions since then with a total of $4000. Does the $3000 oop max pertain to copays before max benefit is hit? submitted by /u/Lucyloufro [link] [comments]Read Morer/HealthInsurance