On January 1, Mrs. Smith tries to fill her prescription for Januvia. Her insurance company returns the claim as paid, but with a very high co-payment, even though the last time she bought it in December it had a $10 co-payment. What is most likely the reason for this?

Question

Quizplus · Accepted Answer

Mrs. Smith has most likely not yet met her deductible for the New Year. Some insurance plans have a deductible, a set amount the patient has to pay out of pocket, before the insurance company will begin covering their medications. This is often reflected through increased co-payments for patients who have not yet met their deductible. Many insurance companies renew the deductible at the beginning of the year.