While unusual - Copay Increases can happen as a mandate of your insurance company. Phil partner pharmacies do not increase or inflate copayments, but only charge exactly what your insurance company mandates. Here are some common reasons for an increases in co-payment:
Deductible: Many insurance plans carry a deductible that can vary in size. A deductible is an amount of money that the subscriber of the plan (and their dependents) are required to pay before their coverage begins to pay for medications or medical services. Your insurance provider should be able to easily inform you of this by calling the member services line and asking for your Pharmacy Benefits Deductible. You can often find this information by logging into your insurance company’s website to review your benefits. Deductibles are a common reason for increases in copay during January- March or if it is a new insurance plan for you.
Preferred Provider Plans: Some pharmacy benefits plans require a specific pharmacy or locale to your registered address for your copayments to remain the same. Unfortunately we're unable to work around this to keep your copay the same because it is the insurance company placing the restrictions on the plan. Please reach out to our team: firstname.lastname@example.org to investigate your options.
Change in Formulary: Insurance Companies retain the right to change the medications they will cover at any given time. Some medications are able to be covered under a “prior authorization” which we would be able to help you obtain in most cases. However, if they changed a medication to be "non formulary" it is suggested that they won't cover it, and your physician should be made aware to find out if there is an alternative medication available for you.
Coupon Expiration: Some branded medications have a coupon that assists in covering the cost of the copayment. Depending on the terms of their fine print, these coupons can expire. We will apply any new coupon, when possible. Unfortunately we are unable to use any manufacturer’s coupons when running Government Sponsored insurance, as it is against Federal regulation.