Why can a given medication’s total price vary for two different patients covered by different insurance plans?

Methods for calculating deductibles and co-payments vary between the public and private systems. They also vary from one private insurer to the next, and are based on the coverage provided by employers and insurers. As a result, it is normal for two patients covered by different insurers to pay different amounts. 

For individuals covered under the public plan: The contribution from patients covered under the public plan, which includes the deductible and co-insurance, is set by the government, based on various criteria. 

For individuals insured through a private plan: The amount payable for your prescription is determined by your insurer, based on your plan’s coverage. Professional fees are set by the owner-pharmacist based on the drug’s complexity and the specifics of a pharmacy’s business. The price of a given drug will be the same for all patients in the same pharmacy. 

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