CoPays

TAP wrote about stupid people who complain about their drug co-pays because they don’t read their insurance policy.

I don’t complain, but I have asked questions a couple times.  Because I do read my policy.  It quite clearly states that my co-pays increased this year.  Drugs on the $5 list went up to $10 (most of my meds), the $20 list increased to $25, and according to my insurance company if I happen to need a medication in the most expensive category, it will now cost me $50 instead of $40.

This policy, however, doesn’t translate into the real world.

I understand that methotrexate increased to $7.40 over $5.60 because my dose increased.  Yes, this is less with insurance than the cash price of $21/$14, and I appreciate it.  What I don’t understand is why it’s not $10 or $25.

Why $3.80 for ibuprofen or $3.86 for piroxicam?  How does that $10 co-pay sometimes become $7.25 or $3.10 when the cash price of the drug is well above that amount?

Is all of this to keep me from squawking when I’m charged $10.99 every month for my plaquenil?  It works.  I pay that extra $12 per year because it seems like I’ve saved even more on other meds.

Read my policy on prescription benefits?  Definitely.  Understand what the pharmacy charges?  Not a chance!

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6 thoughts on “CoPays

  1. I’ve never really understood co-pays at all, to be honest. Seems to me that when we pay a premium each month, the co-pay ought to be included. Being as the insurance and pharmaceutical industries pretty much control how much we’ll pay (and what they’ll cover and whether they want to use all that money they get from all of us to actually provide us with medical care), charging this extra fee just feels like one more rip-off to me. Or rather, it did, until I lost my job and my health insurance.

  2. Just saw this post and as a pharmacy technician, I wish we in the pharmacy could explain your copays too. All we do, when we submit a claim…is transmit the claim and get a price back. I have absolutely no idea why your insurance company gave me a 3.80 copay when your generic copay is 10…and I kinda don’t appreciate when people assume that I have every handbook to every plan of every insurance company so that i can take time out of treating my patients and look up their specific plan? I usually tell patients to call their benefits coordinator…they may have vague answers but they certainly have more information on your plan then i do. It’s the same reason I don’t really understand why some people with the same carrier as i do pay a certain amount for their med and when I get the same med, it’s more expensive? It’s each persons specific premium and plans and I, as a pharmacy tech, am not privvy to that private information

    I am kinda confused as to why you’re complaining about an amount that is less then your copay. Do you believe that we pharmacies lower your copay on certain meds just so we can “overcharge” you on others? I’m sorry to be rude, but that’s complete BS…like I already mentioned…WE DO NOT SET COPAYS…that is done by your insurance company after we submit a claim.

    The only time that I have ever seen an amount drop below a copay that I can actually explain is that in our pharmacy, if the cash price is discounted and it’s way below the copay amount, some insurance companies will choose the lower amount to designate as a “copay”. say a drug is a cash price of $5.00 and your generic copay is $10, sometimes i’ve seen the copay automatically convert to the lower amount.

    • There’s a difference between complaining and asking questions. I don’t complain about saving money. I ask questions about why the insurer says that the pharmacy determines the price, and the pharmacy says that it’s on the insurer’s shoulders.

      I have another post about this topic scheduled to go up next week.

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