I have had no co-pay for my prescription for over two years. All of a sudden, and without any prior notification I was forced to come up with $9.00 in co-pay, and I did not bring any money with me. I had to return home and get the money. I would like 3 questions answered:

1 Why wasn’t I given any notification for the very high price?
2. Why was the price raised so high after being free for over two years?
3. How much more will it be raised next year and in subsequent years?


Your insurer uses a drug schedule (drug formulary) to determine what tier a drug is on and it's price. They can change these without notice. It has no direct relation to the Affordable Care Act (although the ACA did help lower Medicare drug prices). That being said it's one of the parts of the health care industry that is lackluster. The whole drug pricing thing is a rabbit hole. It's hard to compare a plans formulary when shopping because they can change mid-policy. Certainly an aspect of healthcare that needs further reformation.

To answer your other questions, there is no way to tell what your insurer will do.

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Valerie on

I’m sorry, thats BS. Something else is going on. I am have also not paid co-pays for over two years (during Trump administration). As soon as Biden took office and signed all his executive orders, ALL my prescriptions – every one of them all different tiers and different prescriptions started back charging copays.
Before you start saying it was my insurance – it was not, they don’t change until June, I know, I’m the administer of my company’s insurance programs.
Before you start saying my pharmacy is no longer a pharmacy of choice – i checked that too, they are still a pharmacy of choice.
And before you start asking about my deductible – my insurance does not and never has used prescription medication copay towards deductible – I checked again.
When I asked the pharmacy, they said that everyone’s been asking.
Funny, you can’t find anything being reported on this – don’t you love the new America.