10 Reasons Why You May Be Paying Full Price For Your Medications - 4. Retail Price Less than Co-Payment

(4) Retail Price Less than Co-Payment - The co-payment for your medication is more than the retail cost of your drug. For example, if you are using a medication that has a retail cost of $58 and the co-payment of the medication is $60, you will always pay the lower cost, or in this example the lower cost of $58. Remember, if you think that one of your medications should be covered at a lower tiered co-payment, you can also file a formulary exception with your Part D plan and ask for the change. Again, you can appeal a denied formulary exception request. For instance, if you had the same Part D plan in 2008 and your medication was covered at a $30 co-payment and in 2009 the same medication has been raised to a higher co-payment tier (instead of $30, the medication cost $60), you can ask your Part D plan for a formulary exception where there the medication co-payment would be reduced back down to the lower co-payment tier. The PDP-DrugFinder can show you which tier your drug falls into and which tier it is in on all other plans in your state. You can use this information to help you decide if you should request a tier exception. Example: if your medication is a Tier 3 drug on your plan, and a Tier 2 drug on most other plans, you may have good grounds for requesting a tier exception.

Also See:
1. Member ID Card Problems
2. Still in Initial Deductible
3. Non-Covered Prescription
5. In the Donut Hole
6. Quantity Limit Exceeded
7. No Prior Authorization
8. Referenced-Based Pricing
9. Out of Network Purchase
10. No Prescription is on File