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?


Answer

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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