Calculator
Insurance vs Cash Calculator
“It's covered” is not the same as “it's cheaper”. An unmet deductible means the first several fills are charged at the plan's full negotiated price, which is frequently more than the cash price for the same fill. Enter your own deductible, copay, plan price, cash price and expected fills, and see the two annual totals side by side.
Calculator
How many times you expect to collect the prescription over the next twelve months. A 30-day supply collected every month is 12; a 28-day supply is 13.
What is left on your plan's deductible right now. Zero is a real answer here, not an empty box — enter it if you have already met it.
What the plan says the drug costs — the figure that counts against your deductible while it is unmet. Your explanation of benefits or the pharmacy can tell you.
What you pay per fill once the deductible is behind you. Zero is a real answer if the drug is covered outright.
What one fill costs paying cash — a discount card, a manufacturer's direct price, or a compounding pharmacy's rate. The route that ignores the plan completely.
All six boxes need an answer. Two of them accept zero — the deductible and the copay — and zero there is an answer, not a blank. Nothing is computed until every field has one.
The model, stated plainly
Every fill is charged at the plan's negotiated price while the deductible is unmet, and that spend counts against the deductible. From the fill on which the deductible runs out, the copay applies instead — and on that one straddling fill you pay both the last of the deductible and the copay.
That is the common shape of a US pharmacy benefit, and it is deliberately the simple shape. It does not model coinsurance as a percentage, an out-of-pocket maximum, a separate specialty tier, a copay accumulator, or a plan year that does not start in January. Every one of those exists on real plans and every one of them would move the number. Where your plan has one, treat the figure here as a starting point and rerun it with the real terms in front of you.
The thing that catches people out
A drug being on the formulary is a statement about coverage, not about price. Until the deductible is met, coverage means the plan has negotiated a rate and you are paying all of it. On a high-deductible plan that can be several full-price fills before a copay ever appears, and for the whole of that stretch the cash price may be the cheaper one.
The reverse trap sits on the other side of the same line. Cash spend usually does not count toward the deductible — so a year spent paying cash can end with the deductible exactly where it started, which matters for everything else that year might bring. The calculator flags this whenever cash comes out ahead, because it is a cost that does not show up in either total.
And a deductible resets. A calculation run in November, with most of the year's deductible already behind you, says nothing about January.
What this calculator does not tell you
Key terms
- Deductible
- What you pay yourself before a plan starts sharing costs. Until it is met, a covered drug is charged at the plan's negotiated price and you pay all of it.
- Negotiated price
- What the plan says a fill costs. It is the figure that counts against your deductible — and it is not the same as the list price or the cash price.
- Copay
- A fixed amount per fill once the deductible is behind you. Zero is a real value if the drug is covered outright.
- Cash price
- What a fill costs paying outside the plan entirely — a discount card, a direct-from-manufacturer price, a compounding pharmacy's rate. Usually does not count toward the deductible.
This tool performs arithmetic only. It is not insurance, medical or financial advice, and it knows nothing about your plan beyond what you type. Check the figures against your own plan documents and your pharmacy before acting on them. For prices we have verified first-party against a provider's own checkout, see our price-honesty boards.