Open Enrollment 2022: Understanding how your pharmaceutical profile works in each health plan option

2022 Open Enrollment: Understanding your pharmaceutical profile

Prescription drug coverage is included with both Vanderbilt health plan options for 2022, but costs apply differently depending on which plan you choose. You should evaluate your prescription costs to determine the price you will pay under each plan.

Choice CDHP prescription costs

The Choice CDHP has a combined deductible, meaning that both your medical and prescription costs will count toward your deductible. This means you pay the full cost of prescriptions (and medical costs) until your deductible is met. Once the deductible is met, your prescriptions will be covered at the applicable co-insurance percentage.

  Retail Network Pharmacy
Co-insurance 20%
Individual Deductible $2,000
Family Deductible $4,000

Select PPO prescription costs

Select PPO prescription costs are based on co-pays for generic (maintenance and level 1) drugs and co-insurance for brand (retail) drugs (levels 2 and 3). Co-insurance means you’ll pay for a percentage of the brand drugs, not a flat dollar amount like a co-pay. There is a calendar year prescription co-insurance and co-pay limit of $2,500 for individuals or $5,000 for families.

Select PPO In-Network Prescription
Annual OOP maximum Amount
Individual $2,500
Family $5,000


Drug Level Retail Network Pharmacy
(up to 30 days)
Mail Order/Pick Up
(up to 90 days)
Maintenance Generic* $1 co-pay $10 co-pay
Level 1 $15 co-pay $45 co-pay*
Level 2 30% coinsurance w/$150 max 30% coinsurance w/$450* max
Level 3 50% coinsurance w/$200 min 50% coinsurance w/$600* min
Specialty 10% coinsurance w/$200 max no coverage

Please note: These amounts are incorrect in the home mailer. Please refer to the detailed guide or this article for correct amounts.

Scenario 1 (For illustrative purposes only; cost estimates assume using a retail network pharmacy.)

John Doe is taking a monthly, level 1 maintenance drug that costs $150. He will be enrolling in individual health coverage for 2022. He is not planning for any major health issues this year but will have his annual checkup.

  • Under the Choice CDHP, he will pay the full $150 every month until he reaches his combined medical and pharmacy deductible of $2,000. Once he reaches $2,000, he will pay $30 (20 percent of $150) co-insurance each month for his remaining pharmacy costs until his combined pharmacy and medical costs reach the annual out-of-pocket maximum ($4,500). At that point, the plan will pay all additional pharmacy and/or medical costs for the remainder of the year.
  • Under the Select PPO, he will pay a $15 co-pay every month. Note: There is an annual prescription-only out-of-pocket maximum of $2,500. Once it is met, prescriptions are covered by the plan at 100 percent.

Scenario 2 (For illustrative purposes only; cost estimates assume using a retail network pharmacy.)

Jane Sampleton and her family take several prescriptions a month that cost a total of $1,200. She will be enrolling in family health coverage for 2022.

  • Prescription breakout:
    • Level 1 $100 ($15 co-pay)
    • Level 2 $100 (30% coinsurance)
    • Level 3 $1,000 (50% coinsurance)
  • Under the Choice CDHP, she will pay $1,200 every month until she (in combination with her other family members) reaches the family deductible of $4,000. Once she reaches $4,000, she will pay $240 (20 percent of $1,200) co-insurance each month until she reaches the combined pharmacy and health plan out-of-pocket maximum of $9,000. Once the out-of-pocket maximum is reached, the plan will pay 100 percent of all remaining medical and pharmacy expenses for the rest of the year.
  • Under the Select PPO, she will pay $545 every month ($15 co-pay and $530 in co-insurance) until she reaches a prescription only out-of-pocket maximum of $5,000.