MY COPAY IS WHAT??????!!!!

You're angry. Actually you are so mad you could bite the through the child-proof cap on your prescription bottle and spit plastic bullets through the pharmacy tech! Your copay went up again!!!

First...I want you to take a deep breath and put the gun down. I'm going to talk you through this and save you some serious grief...but I need your full attention. Like the hair club ad...I'm not only a pharmacist...I'm a patient too...and I know how frustrating this is. I am going to talk you through this...so stop sharpening the hatchet and listen up.

To begin with, I need to explain to you what DID NOT just happen. Please read carefully:

The pharmacy DID NOT deliberately raise your copay to help pay for rising expenses, fund elaborate cocktail parties, or send our technicians on a luxury cruise to the Bahamas. Your pharmacists did not collaborate after hours on a plan to make your life as miserable as possible. In fact, the pharmacy did not change your copay at all. Your copay is set 100% by the insurance company which you have chosen or been given. And yes, they can change your copay for ANY REASON they want.

Your copay DID GO UP for one of these reasons:

1) The medication has been moved to a higher tier. Prescription plans assign "tiers" to your drugs. Given the rising costs I think they should be called "tears" rather than "tiers". Most plans have 2 or 3 tiers, some have 6 or 7. Generics are generally tier 1. This is your lowest copay. However, remember, YOUR lowest copay is not necessarily the same price as your Cousin Tim's lowest copay. It could be $5.00, $10.00, or any other dollar or % amount they chose. Brand name drugs (that may or may not have generics available) are usually your higher tiers. And they can move up and down (usually up!) the tier ladder whenever your insurance company feels the need to punish you for taking the medicine your doctor has prescribed.

2) Your drug has become "non-preferred" on your health plan. Similar to "tiers" sometimes your insurance company simply assigns drugs to a status of "preferred" or "Non-preferred". What does that mean? A non-preferred drug is a drug which your insurance company in essence wishes you wouldn't have to take! They would prefer your doctor pick another proverbial drug card from the deck. This other drug may or may not work of course...but it probably costs your insurance company less...so they try to encourage using preferred drugs by charging an astronomical copay for non-preferred drugs. And just because your drug was preferred last month does not mean it will be preferred this month. Like New England weather...if you don't like it...wait 5 minutes and it will change!

3) You have exceeded your benefit amount. In other words, your plan allows you "X" number of dollars per year. Once you have used up your "X" number of dollars....WHAMO!...you begin paying full (or nearly full) price for your drug.

4) Your plan wants you to go mail order. Some plans start charging higher prices for your prescription after 2 or 3 fills at a retail pharmacy. They figure, if you are going to be on it every month...order it through their mail service...which saves them money. Of course, that requires you to mail in your prescriptions, and then patiently wait for your drugs all the while hoping that your mail carrier doesn't hear the tempting rattle of pills and wonder what could be inside! No offence to all the fine and upstanding mail carriers out there...I know none of you are responsible for my DVD's that sometimes come already opened and 3 days late!!! Next time I'll stick a bag of popcorn in the mailbox for you to enjoy with the show.

SO WHAT SHOULD YOU DO...I MEAN...SOMEONE NEEDS TO BE SHOT!!!

Okay, once again, deep breath. I am going to share a few secrets which will save you money, grief, and hopefully the lives of a few fine pharmacists out there.

1) Ask the pharmacist or technician if there is anything different about the way your prescription was filled this time than last time. Say something like "I think this is more expensive than before, can you check to see if this is the same medication and quantity as last time?" Maybe the prescription was filled for 3 months rather than just 1. Maybe you used a different insurance card last time. Or maybe...just maybe...though it is highly unlikely...you might have mistaken what you paid last time for this drug with your copay for another medicine.

2) If your copay did go up, you can leave the prescription at the pharmacy and ask your doctor for a less expensive alternative. You see, unlike many unscrupulous medical professionals, your pharmacy does not try to scare you into picking up your medication and then bill you for some outrageous amount which you then have to pay because your insurance didn't cover this or that test, procedure or appointment. WE DON'T DO THAT!!! We take your prescription, bill your insurance (sometimes after numerous phone calls and prior approval overrides), fill your medication, label it, check it, verify that it won't conflict with any of your other meds, bag it, file it, counsel you and answer all your questions. And after all that...if you don't want it...YOU DON'T OWE US A PENNY!!! Nada. Zip. You are free to go. Tell me...does any other medical profession do this??? Does it sound like they are trying to cheat or rob you??

There are almost always options. If you are on a brand name drug with no generics then it is very likely your drug just came on the market in the past few years. That means that for several thousand years of human history drug "x" was not around. In other words, folks lived without it. They survived, and you will too. So unless you are being treated for a rare disorder for which only 1 drug exists in the world...you have options.

3) You can call your insurance. On the back of your card is an "800" number. Tell them your story. Ask them why your copay went up. These folks can actually "see" the claim submitted by the pharmacy and can tell you exactly why you are being charged that price. But beware...sometimes you will get a sluggard who could care less about your problem and wants to go back to his game of online chess. They will typically say something like "your plan hasn't changed; the pharmacy is billing it wrong". ALWAYS, ALWAYS, ALWAYS ask this individual for their full name and phone number for the pharmacist to call them. And I promise you they will almost ALWAYS change their story. They've been caught! Now they actually have to drag their lazy bodies away from the bon bon box and look up your claim online. Low and behold...they now explain that your benefit has changed, your copays have changed, or their was a system error on their part.

So...save the hatchet for fire wood and your gun for the real crooks...you now have all the tools you need for conquer your copay crisis!

For more helpful tips, check out my article on 10 Tips to Save Thousands on your Prescription!!

Best wishes!