GLP-1 Copay Assistance Gap Calculator
Translate GLP-1 list prices, coinsurance, and assistance caps into real monthly cash flow. Enter your list price and coinsurance rate, then optionally add deductible balances and out-of-pocket limits to see how copay cards reduce spend and when you still face uncovered exposure.
Outputs assume steady pricing and eligibility. Verify program rules with your insurer and the drug manufacturer.
Examples
- $1,079 list price, 20% coinsurance, $150 copay cap, no deductible, default OOP max ⇒ Monthly patient cost after assistance: $65.80 • Manufacturer assistance applied per year: $1,800.00 • Annual patient exposure after caps: $789.60 • Annual out-of-pocket stays below the plan maximum.
- $950 list price, 30% coinsurance, $750 deductible remaining, copay cap left blank, $5,000 OOP max ⇒ Monthly patient cost after assistance: $750.00 • Manufacturer assistance applied per year: $720.00 • Annual patient exposure after caps: $5,000.00 • Annual out-of-pocket hits the plan maximum; costs drop to $0 for the rest of the year.
FAQ
How do I model a flat copay instead of coinsurance?
Approximate the flat payment by entering a coinsurance percentage that produces your fixed amount. For example, a $25 copay on a $900 fill is roughly 2.78%.
How do accumulator programs affect the result?
If your plan uses a copay accumulator, set the manufacturer cap to $0 so the assistance does not count toward the out-of-pocket maximum.
Can I include a family deductible instead of an individual deductible?
Yes. Enter the remaining family deductible balance; the tool applies it to the monthly fill before calculating coinsurance.
Why does the annual patient exposure stop increasing after a point?
Once the projection reaches your out-of-pocket maximum, ACA-compliant plans cover additional in-network costs at 100%, so the calculator caps your spend at that limit.
Additional Information
- Deductible balances are assumed to apply to the current fill; future fills should update the remaining deductible accordingly.
- Manufacturer support is capped at the lesser of the entered assistance limit or the coinsurance amount owed after any deductible.
- Annual exposure is limited by the in-network out-of-pocket maximum you enter to reflect statutory plan caps.