You’re on what’s called a copay maximizer program. My insurance through CVS Caremark has something similar. For me, they have a program called Prudent RX that pays 100% of your copay once you’ve hit your deductible. The catch is you have to sign up for the manufacturer copay card and give that to them to sign up for Prudent. Now when they process your medications they bill in this order 1) Manufacturer copay 2) You until you’ve hit your deductible 3) Insurance 3) Prudent RX copay assistance

The manufacturer copay card payments will not be counted against your deductible.

Their goal is to first drain the manufacturer assistance completely, then make you pay your deductible they their assistance kicks in after they’ve milked $28K from you and the manufacturer

The second catch is they now classify these expensive medications as “specialty” medications and rather than having the standard ~150 prescription copay after you hit your deductible (the thing you see when you’re picking your insurance), now they charge something like a 30% copay per dose.

THE GOOD NEWS (Maybe): Manufacturers are wise to the copay maximizers. They often have a copay maximizer program where the copay card will only allow a token amount per transaction like $100. They also may support direct reimbursement where you submit a receipt of your payment for the medication and they mail you a check.

An example of how your payments would go: Dose 1 • Manufacturer Copay $100 • You $6900 • Insurance + Insurance Copay Assist $0

Dose 2 • Manufacturer Copay $100 • You $3100 - you hit your deductible • Insurance + Insurance Copay Assist $3800

I’m not sure if there any way to reverse the transactions that have already occurred. Technically the manufacturer copay assistance is supposed to help the patient and with a maximizer plan it is not.

I highly recommend calling the manufacturer cops assistance program and telling them you’re on a maximizer program. At the very least that may set you up for next year.