I can see how it is confusing, however it is the medical institution/pharmacy that manages the co-pay amount collected from the patient at the point of sale. This varies based on the patient's age and income level. The insurer will pay the flat NHI Price List figure regardless of the patient's age or income level (assuming approved by the CRRO). Here's an example from administrator/insurer Toshima City (a local municipality, will manage if the eligible resident doesn't have employer-based insurance):
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