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

[trifo]

@prettypeacock1 At the beginning of the year

 

[prettypeacock1]

@trifo I would recommend checking again. Formularies can and are updated often. If they are no longer covered you will have to pay the 120 per month or ask for alternatives that are covered.

 

[mentionablegrace]

@trifo Maybe you just haven't met your deductible yet.

 

[christfollower1038]

@trifo Check your formulary to see what tier the rx falls under, then reference your SBC to see how it’s covered. Some plans have “preferred” in network pharmacies with lower copays. $1 to $60 is a big jump though. I have a feeling it’s generic vs name brand.

 

[resjudicata]

@trifo Check Amazon pharmacy. Many of my scripts are cheaper there.

 

[twins4me]

@trifo Check the cost at Sam's and/or Costco. If they are monthly meds, you might be able to get 90 days for a 2 month price through your insurance's mail in pharmacy.

 

[michellemariebru]

@trifo Your insurance may have changed. Your annual notice of change should have detailed any changes.

 

[tvproducer]

@trifo Check goodrx. They list the retail prices for meds. (the cost before coupons). There is an incredible range. You would think retail is retail and would be the same for all pharmacies. But that's not true.

I've found that some of the major chains have extremely high prices compared to someplace like Walmart.

Also, some medications are super cheap depending on the pharmacy. For example my local grocery store pharmacy will only charge $1 for any antibiotic. There's one antibiotic that costs $500. But it's $1 where I go.

 

[daveosu54]

@trifo Is it for a 30 day supply or a 90 day supply?

Call insurance and ask if the formulary changed or if pharmacy tier level changed.

 

[trifo]

@daveosu54 I think technically 30 days but it’s a cream and nasal spray

 

[daveosu54]

@trifo Do you mind me asking which nasal spray? If it’s Flonase, azelastine, or Nasacort, those are available OTC as well (same strength as rx) and might be cheaper if the insurance price is accurate.

 

[trifo]

@daveosu54 Azelastine. I also get Flonase but it’s covered by my insurance

 

[daveosu54]

@trifo That one is Astepro OTC. It’s about $30 on Amazon unfortunately. Goodrx might make it cheaper to get it through prescription if you can’t get your insurance worked out.

 

[maggielee]

@trifo Astelin nasal is OTC, other formulations aren’t, perhaps the formulation you have is non-formulary now. I recommend calling the insurance and hopefully getting a knowledgeable rep.

 

[juanhoward]

@trifo Every January insurance companies change their "formularies"...the list of what they will or won't pay for.

Call or log in and check your drugs in the 2024 formulary. Not covered?...that's your answer. Covered? Then contact them about why you were charged and how to submit your receipts for reimbursement.

 

[mommymaid]

@juanhoward I have 3 maintenance prescriptions and in the past, insurance fully covered 1 and I had to pay copays for the other 2. This year, all three are now fully covered so my copay is zero. My wife gets a prescription that a generic was approved by the FDA last fall. We received a letter saying that the doctor now needs to prescribe the generic for her otherwise the prescription will not be covered.

 

[osuntubot]

@trifo Check to see if it needs preauthorization, make sure CVS has your current insurance on file (and they're attempting to bill your current insurance, not a past one*). Otherwise call your insurance company and find out why they're not covering it.

* I had an issue with my pharmacy billing old insurance on refills despite having my new insurance; old insurance kept kicking it back at the cash price because I had switched to a different insurance. Anything my doctor sent in was going through the new insurance, but refills done via the pharmacy were defaulting to the old insurance. It was easy enough to fix one at a time, but a pain when, say, I was refilling 3 at once.

 

[indesco]

@trifo As an insurance broker, I like to tell my clients to use goodrx or Canada drugs if they want a discounted price

 

[magrietha]

@trifo There is so much that could have affected it. For one, my pharmacy often doesn't inform me whether I'm paying the copay or the full price. A prescription that is $30 elsewhere is $9 at my pharmacy and I know my copay is at least $15 for any medication so obviously it's the same price for everyone. If I did go to the other pharmacy where it's $30, maybe I would get it for $15, I don't know.

 

[newfaithfull]

@trifo Write an appeal letter to dispute the cost.