03/12/2026
"A question pharmacists hear every day is:
“Why did my copay go up?”
When that happens, pharmacies double check the claim to make sure everything processed correctly. But many patients are surprised to learn that pharmacies do not set copays.
Copays are built into your insurance plan design. In many cases, the rules behind those costs are managed by Pharmacy Benefit Managers (PBMs), which help determine formularies, drug tiers, and cost-sharing structures.
That means pharmacies simply apply the system rules when a prescription is processed.
This is why many healthcare leaders are pushing for more transparency and reform in the PBM system, so patients can better understand how prescription prices are determined.
Have you ever had a copay change that surprised you?
Help advocate for clearer and more transparent prescription pricing.