How your pharmacy benefits work 1 2 3 4 5 Show your ID card at the counter Give the pharmacist your medical (and/or pharmacy) ID card when you pick up your prescription. Your prescription is priced The pharmacy runs your prescription through your insurance and tells you what you owe at the counter. Payment process depends on plan type HDHP: pay the plan's discounted cost for prescription until you meet deductible. PPO: pay copay for covered prescriptions (deductible does not apply). As your prescription costs add up… HDHP: met the deductible? You may be responsible for a copay or coinsurance and then your plan pays the rest. PPO: copays continue, but generally will count toward your out-of-pocket maximum for most plans. OOP met? You pay nothing Once you hit your out-of-pocket maximum, the plan pays 100% of covered prescriptions for the rest of the plan year.