Double copay for the same prescription- help!

I take a daily medication that I rely on to function and be productive. My doctor has prescribed me a 65 mg dosage, which comes in capsules. The available capsule strengths are 10 mg, 18 mg, 25 mg, 40 mg, 60 mg, 80 mg, and 100 mg. To get my prescribed 65 mg, I take a 40 mg capsule and a 25 mg capsule. However, when I go to the pharmacy, they treat these two pills as separate prescriptions and charge me a copay for each one. It’s frustrating!

I currently have Kaiser as my healthcare provider, and I’ve talked to countless people—from billing to pharmacy staff, my doctor, and customer service—about this issue. Unfortunately, no one has been able to help me resolve this double payment. The best suggestion I’ve received is to change my prescription to one of the available strengths. That’s infuriating because I’ve already tried other dosages, and they don’t work as well for me. One person I spoke to mentioned that I’m not the only one facing this problem.

It seems crazy to me that anyone should have to pay a double copay just to get the dosage they need. But hey, this is America, so maybe I shouldn’t be too surprised.

I’m not one to accept this without a fight, so I’m looking for help. Has anyone else experienced this? Have you found a way around it? How can you get exceptions for medication you need to function?

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That’s your insurance at play. To be blunt, there probably isn’t much difference between 65 mg and 60 mg other than your perception. What makes your doctor think that 60 mg or 80 mg won’t work, but that 65 mg randomly a quarter of the way between those doses will?

Why shouldn’t you have to pay a copay for each pill if you’re getting two different prescriptions? Just something to consider.

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As a pharmacy tech, I can tell you this isn’t a “double” payment; you have two separate prescriptions to pay for. There’s no flexibility for combining different dosages to equal one. You have to fill two prescriptions at two different strengths and pay for both.

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So how can we fix this totally broken insane system? This makes no logical sense. Insurance is such a scam.

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I’d argue that it makes logical sense—you’re using two products that require research, production, and packaging. Just because you need a dosage that isn’t commercially available doesn’t change the fact that these are two prescriptions.

That said, I share your frustration with the American healthcare system. It’s broken, and every day, thousands of people go without medications they can’t afford, like insulin, blood thinners, and specialty drugs. If you can’t pay, you simply don’t have access to them.

If your medication is a brand-name drug, the manufacturer might offer a copay assistance program. If it’s a generic, GoodRx might provide better prices than your insurance. I’m guessing you earn too much for Medicaid or other assistance programs for medications. Unfortunately, your main options are to switch to a strength available in one pill—which is why you’re getting that infuriating advice—or to pay more for an insurance plan that offers the medication at a lower cost.

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Do you consider this a scam?

Many of us who notice scams decide to either continue with them or handle them in our own way.

You have the option to not fill prescriptions if you think they are a scam; you can choose to fill them based on your needs, costs, and preferences.

I wonder if the original poster has asked their doctor if a 60mg or 80mg dose will work instead of posting here for a solution. We have no control over the prescriptions given or the capsules that are manufactured.

In health…

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It is two different prescriptions because they do not have a 65mg pill so your doctor prescribed a 40mg and a 25mg.

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It is two separate prescriptions. I understand how frustrating this must be for you, but they are filling two different bottles with two different strengths: 40 mg and 25 mg. If the cost is too high, your best option is to look for manufacturer copay assistance.

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Talk to your doctor about it.

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This is literally two different prescriptions, you’re welcome

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That sounds really frustrating! Can you ask your doctor to write a new prescription for a single 65 mg pill? If that’s not possible, they might be able to make an exception for you. Kaiser could help with this, too.