The deductible can be absorbed in part or in full by medication copay assistance programs, like Apriso/Delzicol/Pentasa copay cards. Same goes with remicade/humira, the copay assistance program can eat up a lot or all of it.
Billing for biologics is pretty darn hard to figure out in advance. If there is an injectable med copay, often $150 or 300, then you would be responsible for that. Or might be called a specialty-pharmacy fee/deductible.
Correct me if I am wrong but I don't think that the discounts from the manufacturers count towards your yearly deductibles. So according to my insurance policy my Stelara does should cost $50 but after the co-pay assistance program I am only charged $5. The $5 is what goes towards my yearly deductible.
Without surgeries or hospitalizations I never maxout my yearly deductibles. I think my yearly deductible is either $1,250 or $1,500 (I forget).
If I was doing the math then I would figure out the copays for 6-8 doctor visits, 4 blood draws, and what it would cost me for my current medications for the year under each plan and if I could get co-pay assistance. Then I would figure what the difference in costs for the two plans would be and at what point the 2nd plan becomes more advantageous.
DX'd with Severe Pancolitis June 2005
Previous Meds: 5ASAs, Predisone, 6-MP. Remicade, Humira, Simponi, Cimzia & Cyclosporine
3-step J-Pouch surgery: 2013 & 2014
Current Condition: Chronic Pouchitis -- Not as bad as I thought it would be
Current Meds: Stelara
Total Hip Replacement: 12/16 -- Thanks Prednisone!!!www.healingwell.com/community/default.aspx?f=38&m=3755226