My drug copay went up — what happened and what can I do?
Likely a formulary tier change. You may have rights to push back.
Copay increases usually happen because the drug moved to a higher formulary tier or because copay-accumulator programs are excluding manufacturer assistance from your deductible. Different fixes for different causes.
Steps
- Call the plan to confirm whether the drug moved tiers or accumulator changed
- If tier change: request a formulary-tier exception with prescriber clinical statement
- If accumulator: check whether your state bans copay accumulators (some do)
- Manufacturer assistance program may still help with out-of-pocket cost
Frequently asked questions
My drug copay went up — what happened and what can I do?
Copay increases usually happen because the drug moved to a higher formulary tier or because copay-accumulator programs are excluding manufacturer assistance from your deductible. Different fixes for different causes.
What are the steps?
1. Call the plan to confirm whether the drug moved tiers or accumulator changed; 2. If tier change: request a formulary-tier exception with prescriber clinical statement; 3. If accumulator: check whether your state bans copay accumulators (some do); 4. Manufacturer assistance program may still help with out-of-pocket cost
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