New Prescription Drug Deductible

All GIC employee/non-Medicare health plans except Fallon Health Direct and Select will include a new separate prescription drug deductible.  This is a set dollar amount you are responsible for paying to your pharmacy for prescription drugs before the plan will pay for your prescription drugs.  Deductibles reset each year.

Prescription Drug Deductible Questions and Answers

Q) How much is the fiscal year 2018 prescription drug deductible?

A) The prescription drug deductible effective July 1, 2017, will be $100 per individual and $200 per family for all plans except Fallon Health Direct and Select. 

Q) How does the prescription drug deductible affect my copays?

A) If the cost of a drug is less than $100, you will pay the cost of the drug, which will go towards satisfying the deductible.  Once an individual reaches his or her deductible, copays apply.  When the family deductible is reached, copay benefits apply to all family members, even those who have not met their individual deductible. 

Examples: 

Family Member 1 orders a 30-day supply of a brand drug that costs $80.  This family member will pay $80 to the pharmacist and will have a $20 deductible balance.

Family Member 2 orders a 30-day supply of a brand drug that costs $105.23.  The family member will pay the $100 deductible plus the balance of $5.23, because the remaining balance is less than the brand copay of $30.  This family member has satisfied his or her prescription drug deductible and will pay copays only for all future prescription drugs.

Family Member 3 orders a 30-day supply of a brand name drug that costs $200.  This family member will pay the remaining family deductible of $20 (see Family Member 1) plus the $30 copay.  The family’s deductible has been met and all family members will pay a copay for any prescription drugs ordered for the remainder of the fiscal year until they reach their out-of-pocket maximum.


This information provided by the Group Insurance Commission .