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If You're Taking High-Cost Medication

The 20% member co-pay for most drugs under the Welfare Fund CVS plan increases to 50% when plan costs for a member exceed $10,000 annually, and to 80% over $15,000.  If you know that your personal prescription drug costs (your co-payments + drug plan covered charges) exceed $12,000 annually, you should consider enrolling in a basic health insurance plan that offers a drug rider. Information is available here on insurance carriers and drug riders in the New York City Health Benefits Program (NYC HBP).

Drug plans differ. When choosing a health plan with a drug rider, be sure that your particular medications are covered by that plan. Be aware of whether the plan’s co-pays for your medications are a flat dollar rate or a percentage co-pay.

Health insurance and drug rider premium charges can be steep, as you probably know. You will need to measure your potential drug co-pay expenditures under the Welfare Fund plan against the cost of premiums charged for NYC HBP insurance plans and riders, as well as their prescription drug co-pay rates.

If you are currently on a prescription drug co-pay assistance program, such as manufacturer coupons, be aware that you are not seeing the actual cost of the medication. 

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