Magic 8 Ball



I swear this is what many people think I do when it comes to insurance companies.

Today was probably one of the more busy days I’ve had in the pharmacy in a long time. I didn’t get time to eat or use the bathroom throughout the day. Luckily, I have a well trained stomach and bladder for days like these. Today’s central theme focused around copays. No matter how many times I tell people I do not know what their copays will be ahead of time, I get at least 5 phone calls every day asking this very question.

Let me set the record straight.

Pharmacies DO NOT know copays ahead of time. We only know what you HAVE paid in the past. We can only tell you the price WITHOUT insurance. Why is this? Well, insurance copays can, theoretically, change at any given time. Practically speaking, most copays will only fluctuate at the start of the new year. But, there are always exceptions to this rule.

Because most pharmacies follow “the customer is always right” motto, we do not want to mislead you with one price and then ask you to pay another when you arrive to pick up your prescription. It would be like a department store saying one thing in their sales flyers and then charging something completely different at the check out line. If we tell you a price ahead of time without knowing for sure, most bigger retail chain pharmacies will feel obligated to honor that price if it is lower many times. If your copay increases from last month, we will feel bad for misleading you and absorb the difference, allowing you to pay what we told you over the phone. If we did this with every person that asked for a copay ahead of time, we’d all go out of business.

Pharmacies bill instantly to insurances, unlike physicians’ offices and hospitals. We know within a few seconds of submitting a claim if it’s accepted and what the cost to you will be. If you can wait for a minute or so while we input the prescription and submit the claim, we can give you the price. If you cannot wait or want to know before ever setting foot in the pharmacy, you need to call your insurance provider for a formulary list and the costs for certain medications. I have done it myself, and it takes about 2 minutes once you get a hold of a customer service representative. Also (for the tech savvy), many carriers post their formulary lists and prices online now.

I would like to know what is so difficult about this concept for people to understand. I get the same people every few weeks asking me the same question about a different medication. My answer is always the same. This is what I feel like saying this after enough times of the same people asking:

“I do not have a Magic 8-ball.
I do not read tea leaves or dice.
I do not have a crystal ball.
Ahead of time, I can’t give you a price.”


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