What is the allowed amount for my medication?

An allowed amount is the dollar amount your plan will pay out for a specific medication. This allowed amount is based on a calculation that incorporates the cost of the medication, the dispensing fee, and an applicable markup percentage for the pharmacy. This valuation is an estimate of what your plan provider decides a medication should cost and what will be paid to the provider of that medication. This is both for you to avoid unexpected costs and standardize the cost of that medication across health providers.

This calculation does not include any applicable copays or deductibles that may be part of your plan, for which you are still responsible to pay on your own. The markup percentage can vary depending on the pharmacy or medication. If the cost of the medication exceeds your plan provider's allowed amount, you might be responsible to pay the difference that is not covered.