A co-payment is a cost that a patient must pay for a drug that is a set dollar amount. Coinsurance is a cost that a patient must pay for a drug that is a percentage of the total cost for a drug. Both of these are known as cost sharing. Coinsurance can be as high as 50% for non-preferred drugs and 33% for specialty tier drugs.
A typical plan will have price differences between non-preferred, preferred, and specialty tier medications. Preferred drugs are the most affordable type of brand-name medications. Non-preferred drugs are more expensive than preferred drugs and carry a higher portion of cost- sharing that the patient must pay. Specialty tier drugs cost more than non-preferred drugs, and have no generic or similar medicine that could be taken instead.
