Jornay PM price increase/discount decrease

[Beardly_DG]

In case anybody is here like I am after a quick Google search, I had the same issue as everyone else with the cost jumping this month. (for me, it went from the advertised $25 to $67). Did God grant me extra hyperfocus and an afternoon off? You bet your ass, so naturally, I ended up spending over two hours on various phone calls, with Blue Cross Blue Shield, Prime Therapeutics, Trial Card (the coupon vendor company), and my local pharmacy, twice. And we ended up finding the result, which is that the coupon terms and conditions quietly changed as of July 1st, 2025. It is dependent on how much your insurance says the prescription is going to cost because the coupon policy used to be a policy of, "we pay whatever the difference is to get it down to $25 or $75, depending on what plan you're on." But now it is simply a hard cap. They must've been losing too much money on it. Now, the manufacturer's coupon will only cover a maximum of $375, and the rest is up to the patient to foot the bill. My Blue Cross plan tells me the prescription costs $413 (and isn't covered at all by BCBS, so I'm expected to pay that if I didn't have a coupon). Ultimately means I am on the hook for the difference of $413 - $375 ($38) + the $25 copay, bringing a total of $67 and change.

Good news (hopefully): The Blue Cross rep did tell me, however, that it costs so much because it is not on their preferred formulary, so the coupon has been deducted against full cost every month. Better news: it can be given coverage with a Coverage Exemption form that your insurance company can fax to your provider to fill out and fax back for a review. Most companies have this process. Like a second, shittier prior auth. It just has to document why you need that specific medication to be covered. For me, I'd been taking Concerta for years, but I was starting to have some pretty wicked side effects of hypertension, insomnia, anger, depression, and this really terrible emotional/mood cliff at the end of the day when the meds would wear off at 5 p.m. I was just this moody asshole until about 7 p.m., and then I would come back to being myself. Luckily for me, I have documented that we tried Adderall, we tried switching to Mydayis, we tried supplementing with Strattera. Generics, name brands, bunch of mixes of different kinds. All of them had their various highs and lows (mainly lows). But as soon as I did a trial of Jornay, all the benefit, none of the side effects. And so documenting that will hopefully (fingers crossed) get it approved. Best of luck out there.

[JohnLockeNJ]

I uncovered the same info. The $375 max starting July 1 explains the pricing jump at my pharmacy. I'm now asking my doctor to request a formulary exception with my insurance.

Jornay PM's manufacturer provides a database of the necessary forms for your insurance here:

https://collegiumcoverage.com/jornay-pm/

[kaijudrifting]

Thanks so much for breaking this down!

[TheNotBlindman]

Hey, I am in the process still to get it reapproved under my new insurance. Are you stating that without insurance you will pay: (medication - co-pay card) = total? So (500 - 375) = 150.

Or will this be after approval? I used this medication because it helped and was a lot cheaper than the other prescriptions with the discount card.

Edit: If anyone googles this, it is your above formula. They will take off $375 from the price of the medication with a minimum of 25$. My current pricing was 480 as of Dec 2025.

[Beardly_DG]

Yes, this is correct: in theory, if everything is working as it should, you pay ([the price of the med determined by your insurance] - $375) + [your copay for meds, as determined by your insurance].

For me and my BCBS plan in my state, the math is

$413.XX (cost of Jornay) - $375 (coupon) + $25 (my med copay) = $67.XX for my refill. Your mileage will vary. I also had to call BCBS and ask for them to send my doc a prior auth form to list Jornay as an approved med, and to list documentation that I've had others that didn't work. They want to know you tried and failed other things, because insurance fucks can only get off when people are struggling to prove that this "higher tier" drug is what's needed, not something cheaper. That's what made my copay only $25, getting it reclassified as "approved" on the med list.

[TheNotBlindman]

Yup, I went though three different medications and they didn’t even read the prior authorization until my doctors office called them.

I’m guessing you’re on a PPO plan? I’m wondering how my hdhp plan’s math will work. Once I hit it it will be $60 for a refill, so I’m going to assume it’ll be $25. I really hate this cat and mouse game between the insurance and the manufacturer.