Drug co-pay went up seven-fold — what to do

My husband and I just joined a new health plan.  Our co-pay for my husband’s medications went from $50 a month to $350.  We can’t figure out if the plan is not covering the drug at all, or we didn’t do something right.  The plan description also does not have anything about a higher co-pay for certain drugs.  When we call the plan, we get different answers and none of them helpful.  What should we do? We cannot afford $350 a month for drugs, plus our health insurance.


Dear Frustrated,

I am sorry that you are having trouble getting your husband’s medications.

The first thing I would do is ask the pharmacy what message they are getting when they submit your drug.  They get an instant message about how much the plan is paying, and also, to some extent, why.  This would at least tell you if the plan is paying nothing (not covering it) and whether the drug is on the plan’s list (called a “formulary”).   The pharmacy should also help you get more information, if the computer message is incomplete or cryptic.

Your doctor’s office may also know what is happening.

If you still come up empty after working with the pharmacy, the doctor, and the plan’s call center, then I would turn to the Bureau of Insurance’s consumer assistance staff.  They can help you appeal the claim or get the correct information that you need

Good luck!


Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.