Prescriptions that use to just have a $1 co-pay now aren’t covered by my insurance

[trifo]

I recently moved and switched my pharmacy to the closest one to my new home which is a CVS. I am prescribed medications from an ENT and a Dermatologist that I’ve tried refilling and expected the usual $1 co-pay that I payed previously for those medications but they both cost almost $60 each because they aren’t covered anymore. Who should I contact about this, the prescribing doctors or the insurance? I only ask because I’m sure I’ll just get a bs excuse from the insurance. I know that they aren’t nearly as expensive as many others’ prescriptions but I’m in a spot financially where I can’t just pay an unexpected $120

 

[tdrowland]

@trifo Insurance first to see if it's covered. You also switched pharmacies, so that could be it. It could be that you were getting generic and now you're not(I think the prescription has to note if that's ok). Finally, some plans really prefer mail order, especially for more than 30 day supply. Anyway, start with insurer

 

[erin30ga]

@trifo Is the new pharmacist in your network?

Increasingly insurers are requiring people to use specific pharmacies they have deals with.

 

[trifo]

@erin30ga Yeah it is

 

[aletia]

@trifo Were they filled in the last couple of weeks? The changehealth cyber attack has caused a giant mess that isn't yet cleaned up.

 

[jeb711]

@aletia Ya I'd bet it's due to this

 

[walid]

@trifo Call into insurance.

They can at least explain what they need or why it is no longer covered/what you can do to get it covered.

We found out we have to apply annually for a pre Auth for a couple of medications. I have another medication I needed to try a specific cheaper alternative for 30/60 days then have my doctor notify if it did not work to their satisfaction in order to approve the more expensive one.

 

[fmontanay2]

@trifo Do you need to meet a prescription deductible first?

 

[vladimirsurguy]

@fmontanay2 This is a good question, or meds could just be subject to the overall deductible (possibly only applicable to certain tiers). OP - you should know that in insurance, “covered” is not necessarily the same as “paid.” There are plenty of circumstances where insurance covers something but you’re still responsible for most or all of the cost. When something applies to the deductible, it IS covered.

 

[minnieys]

@trifo Is that CVS listed as an In-network pharmacy for your insurance? If you're not going to a preferred pharmacy for your insurance that could explain the copay change

 

[trifo]

@minnieys Yeah I’ve gotten other prescriptions there that were covered

 

[celticghirl]

@trifo That doesn’t prove that it is preferred.

My husband has a plan through a hospital network he worked at and they required everything to be filled at the outpatient pharmacy at the hospital, with the exception of “emergency” medications at CVS. So they would do a 1 month fill at a CVS and then the next month reject if you tried again. You had to move it to the hospital outpatient pharmacy.

 

[godfearing00123]

@trifo Amazingly, every pharmacy carries a different price - sometimes significant. We have found CVS to one of the most expensive every time. Definitely shop around. It takes time, but it's worth it. I agree that GoodRx also tends to be a very good option.

 

[maggielee]

@godfearing00123 Yes, I used to part D authorizations & claims and CVS/walgreens would literally put patients into the coverage gap while patients on the same meds at other pharmacies wouldn’t reach it at all. Also they treat their staff like crap, and the patients are worse off for it.

 

[teelea68]

@trifo Also check GoodRX. I saved $80 a month by switching to Wegmans pharmacy + GoodRX versus using CVS + insurance.

 

[resjudicata]

@trifo Definitely contact your insurance. If they give you a "bs excuse," keep escalating. But they should be able to tell you, or at least point you in the right direction.

 

[goodasgold56]

@trifo Azelastine is cheapest at Jewel-Osco, Costco or Walmart pharmacies through GoodRx, though you may have a local brand that has it cheaper. Jewel-Osco and Costco were like $18 and Walmart was like $23.

Costplusdrugs.com the Mark Cuban thing $10.47 for 30ml spray + $5 shipping... you can order 3 of them at a time for $21.41 + $5 shipping it looks like.

 

[prettypeacock1]

@trifo What does your formulary say?

 

[trifo]

@prettypeacock1 They’re covered last time I looked

 

[prettypeacock1]

@trifo When was that? Formularies can change any time.