Ready.← Panel boardNessie demo

Plan year · Maria Delgado · Anthem Blue HSA 3400

Same drug, same plan, same patient: unaffordable for 3 months, then affordable for 9.

The panel board shows one copay because a prescription has one price today. It does not. On a high-deductible plan the same fill is $997.58 while the deductible is open and $199.52 once it clears. Plan design and pay cycle are owned by different systems that never speak, so this crossing has never been on one screen.

Semaglutide (Ozempic) · what the plan charges, month by month above her capacity clears monthly capacity $262.50
$262.50 capacity
$998
$998
$883
$200
$200
$200
$200
$200
$200
$200
$200
$200
SepOctNovDecJanFebMarAprMayJunJulAug
3months she cannot start, at any point in them
Decthe first month the fill fits inside her capacity
$2,878.55what she would have to absorb to reach that month
$4,674.23projected out of pocket across the plan year

Why one copay is a lie

Ask “can she afford this drug?” and there are twelve answers. Three months of $997.58 and nine of $199.52 are not the same product, and a real-time benefit check that quotes today’s number tells her doctor the wrong one for a quarter of the year.

A therapy she can only begin in Dec is a therapy she does not begin. The barrier is the deductible, not the price.

What this changes on the board

A STRUCTURAL verdict in September is not permanent — it is the deductible phase. The same patient is TIMING from Dec, and the right intervention is completely different on either side of that line.

Nothing in a claims feed, a PBM or a benefit tool holds both halves of this chart. One side needs the plan’s accumulators; the other needs her bank.

  1. Plan design → what she owes. Deductible remaining, tier, coinsurance, twelve months of accumulator roll-forward. lib/engine/benefit.ts
  2. Bank ledger → what she can absorb. Payroll cadence, recurring obligations and the essential floor, inferred from posted transactions. lib/engine/capacity.ts
  3. Both → the crossing. The first month the fill fits, and what it costs to get there. lib/ready/planyear.ts
  4. Crossing + clinical window → whether anyone is told. Most of the time, nobody is. lib/ready/liquidity.ts · attention.ts
Where every number came from
  1. Semaglutide (Ozempic) on Anthem Blue HSA 3400. The plan's allowed amount is $997.58 per 30-day fill.
  2. Her monthly capacity is $262.50 — income $2,572.88 less $1,639.17 of recurring obligations and $671.21 of ordinary variable spend. This is a recurring fill, so it has to clear every month, not just today.
  3. Sep: plan charges $997.58 (deductible) — $735.08 more than she has in a month.
  4. Oct: plan charges $997.58 (deductible) — $735.08 more than she has in a month.
  5. Nov: plan charges $883.39 (deductible) — $620.89 more than she has in a month.
  6. Dec: plan charges $199.52 (coinsurance) — inside $262.50, so it clears.
  7. The curve crosses her capacity in Dec, when the deductible clears and the fill drops to $199.52.
  8. To reach that month she would have to absorb $2,878.55 across the 3 blocked months — which is the reason she does not start at all.

Maria Delgado is a synthetic patient — no real health data. The plan is a real-shaped HDHP fixture; the arithmetic over it is the same engine the test suite checks against hand calculations. Capacity is read from the demo Capital One Nessie ledger.