Patient’s Responsibility for Outpatient Chemotherapy

 

Hospital Outpatient Dept./Clinic

Physician's Office

Pharmacy

Chemotherapy Administration 

No copay

Par

No copay

Not Covered

Non-Par

2007 Deductible: $335

Coinsurance: 20% of total charge or R&C Charge, whichever is lower. 100% of any amount exceeding R&C Charge.

Chemotherapy drugs/agents

No copay

Par

No copay

Generic: $5 or $10 copay for up to 90 day supply

Preferred Brand: $20 or $30 copay for up to 90 day supply

Non-Par

2007 Deductible: $335

Coinsurance: 20% of total charge or R&C Charge (AWP), whichever is lower. 100% of any amount exceeding R&C Charge.