My mom's copay jumped 3x after her insurer changed tiers

Last month my mom went to refill her blood pressure meds at the CVS in Dayton and the pharmacist said her copay went from $15 to $45 overnight. Turns out her insurance quietly moved her drug to a higher tier on January 1st, no letter, no email, just a shock at the register. She almost walked away without it, but I called the insurer and they said the formulary change was "standard practice" and she could ask her doctor for a prior authorization. The doctor's office took 4 days to send it, and in the meantime she skipped two doses because she couldn't afford the fill. She finally got the PA approved and the copay dropped back to $15, but I'm still furious about the gap. Has anyone else had a similar tier switch sneak up on them, and did you find a way to get it reversed faster without the wait?

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shane_park9229d ago

My dad had the same thing happen with his insulin last year, except it was worse. He's on Medicare Part D and they moved his long-acting insulin to tier 4 out of nowhere. Copay went from $35 to $110. He didn't skip doses though, he just ate less food to make up for it. Bad idea. He ended up in the ER with low blood sugar because he was trying to stretch the insulin. Took me three phone calls and a fax from his doctor to get it fixed. Took eight days. The worst part was the lady on the phone actually told me I should have checked the formulary in November. Like anyone does that.

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