r/Insurance • u/BluefaceBlues • Nov 19 '25
Health Insurance Amazon Pharmacy Charged $4000 for Dupixent
So we just got stuck with a $4000 bill for a Dupixent prescription, which was previously free.
We were previously using a local pharmacy, but changed to Amazon pharmacy a couple months ago.
We had the Dupixent Copay program set up, which my understanding is that that gets used to cover any costs that insurance does not, and that is limited to $10,000/year.
The first 2 monthly orders through Amazon looked good to us. Zero cost to us. Set to auto-fill.
Come to find out that behind the scenes, insurance was rejecting the prescription, and the entire cost was falling onto the Dupixent Copay.
Now this 3rd month, there are not sufficient funds in the Copay account, and Amazon charges our backup payment method, my Visa, the entire cost of the prescription. I didn't notice until this morning, when it was out for delivery.
We've spoken to the Dupixent support, Amazon pharmacy support, and the insurance company, and nobody claims the ability to do anything.
What can we do?
Update: 6 weeks later, we were unable to make progress with ExpressScripts making an exception and covering this as out-of-network. They denied it twice. BUT, we heard from Chase that they resolved the dispute in our favor. It's been a few days, and we haven't heard anything from Amazon. We're big-spenders with Amazon, so hopefully this is just the end of it.
13
u/milespoints Nov 19 '25
This isn’t really an Amazon pharmacy issue.
Was the insurance rejecting the Dupixent or does the insurance plan include a copay accumulator?
If it’s just a straight rejection then the path forward is understanding why that is, and seeing what they need in order to cover it. If it’s covered, you will at least be expected to pay only the coinsurance, not the full amount
7
u/BluefaceBlues Nov 19 '25 edited Nov 19 '25
Agreed, it wasn't until I was speaking with a supervisor at Amazon Pharmacy that we realized insurance had been rejecting. My wife is the one who ended up speaking to the insurance company though, and I'll have to get clarification on that conversation.
Update: Ok so apparently my wife was told that in order for her Dupixent orders to be covered by insurance, the pharmacy needs to be one that works with Accredo, a speciality pharmacy, and Amazon Pharmacy is apparently out of network in that regard.
4
u/CNickyD Nov 19 '25
Oooh, I see what happened… I have a $12k/month script, and it’s only ever filled at the ins co specialty pharmacy. Most high-cost medications are like this. It sucks that Amazon didn’t notify you first though, that’s a real service lapse…
1
u/cuspeedrxi Nov 20 '25
This is common. You must use the insurance company’s preferred specialty pharmacy. There’s nothing OP can do. The drug is not covered otherwise. The insurance company will tell them this is listed in the plan documents and drug formulary. It would have been nice if Amazon had reached out, but they opted to auto-fill the script, which is the same as telling Amazon not to contact them about it. Unfortunately, OP is not the first person to experience this.
2
u/SiberianWombat88 Nov 20 '25
This is not normal. I work for a mail order pharmacy and we would never just assume a member wants to be charged $4,000 because "auto fill" 🤷♂️
We also don't ship anything that's been rejected by insurance unless the patient specifically agrees to it.
...but now I understand why people are so concerned we're going to ship something that's not covered, though.
10
u/SeriousMind7 Nov 19 '25
Never setup auto fill for an expensive prescription. I have the same medication as you and for this one I refused to even leave a cc on file for them to charge. I also always talk to someone in billing to double check it’s no charge before it’s refilled. Its just crazy how freaking expensive this shot costs. I really hope your able to get that charge back done
2
u/DigmonsDrill Nov 19 '25
I took this reminder to delete my credit card from my pharmacy's account. It was required at some point in the past, and if needed I'll put it back in. It's worth the hassle to avoid a $4000 charge.
2
u/Honest_Wafer2381 Nov 19 '25
Pretty much the same advice as others. I have 2 prescriptions being filled right now that come to about 30k on a quarterly basis. You can believe I am on top of any insurance issues etc. on an ongoing basis, looking at my account online that claims are being processed and paid, etc.
3
u/jjmoreta Nov 19 '25
Ouch.
My own personal rule of thumb is I make sure any medicine is fully approved by insurance and copay before I fill it if I can't afford to pay for it out of pocket. No auto-fills on any prescription either, unless it's through my direct pharmacy.
And yeah Express Scripts and Accredo suck to work with. One of my meds is $80,000 a year retail so yeah I can't handle the copay without manufacturer assistance. So many more extra hoops to have to jump through.
The only bright point I can think of is if you do have a lot of medical expenses, this mistake will go towards your annual out of pocket. If it fulfills it and you have any needed procedures needing copay/coinsurance, you might see if you can get them scheduled this month or next. Might mitigate it a little bit.
Otherwise try and file an internal appeal with Accredo to cover the medication as out-of-network or similar.
3
1
Nov 20 '25
[removed] — view removed comment
1
u/onthedrug Nov 20 '25
Yep, this is a common occurrence. Most doctors do not respond to our PA requests and even simple refill requests.
1
u/onthedrug Nov 20 '25
This is why people shouldn’t use online pharmacies. You are more than likely SOL.
1
2
u/biggerty123 Nov 19 '25
Keep voting for the GOP - they are GREAT with improving the cost of health insurance! /s
-4
u/Calm-Revenue-7707 Nov 19 '25
Call your credit card company and dispute charges. Tell them you were not made aware of the cost before it was shipped. I’ll be honest, it’s a long shot, but I would at least try.
3
u/Head_of_Lettuce Nov 19 '25
This is terrible advice. Do not do this.
-2
u/QuantumLeaperTime Nov 19 '25
No it is not. It was unauthorized. Amazon should have called before shipping if insurance was denied.
4
u/DigmonsDrill Nov 19 '25
OP checked a box at once to authorize this.
My pharmacy calls me to double-check. And they're not some mom-and-pop, but they have employees who handle stuff instead of automating every single possible thing. Because that's basic customer service.
Shitty customer service isn't illegal.
-5
u/QuantumLeaperTime Nov 19 '25
Can you order without checking the box? If not then never order from them. Why would you want them to send you medication without verification of insurance paying for it?
1
u/DigmonsDrill Nov 19 '25
If not then never order from them.
Everything on this page backs you up on this.
When OP put in their credit card, maybe a long time ago, they checked a box saying that it could be used to pay for stuff as a last resort.
I'm confident Amazon has proof of OP agreeing to this, although maybe in a disjointed way. Horrible customer experience but legal. Ultimate result of trying to remove humans from the process. A human stops before billing $1000 medication to a credit card. Heck, my in-person CVS pharmacist will say "wait, this medication costs $350, are you sure?" I am, I realize why you ask, and I'm glad for it, but I'm sure.
2
u/InternetDad Nov 19 '25
Terrible idea when insurance is much more complex than a sinple charge back. It's very possible this can be fixed and OP hasn't been the one talking to insurance trying to figure it out.
2
u/BluefaceBlues Feb 02 '26
Just wanted to reply again directly to this, due to the downvotes you got. This is exactly what I did, among trying everything else also, and this was the only thing that worked.
1
u/Calm-Revenue-7707 Feb 02 '26
Im glad you were able to get it resolved, and hope you were still able to get the prescriptions you need and that you are doing well. $4000 is a lot of money for most families. The downvotes don’t bother me LOL!
2
u/BluefaceBlues Feb 02 '26
Yeah just wanted to clear things up for anyone who stumbles upon this in the future. Everything went ideal, just took a long time to get there. Amazon has not banned us. I still get my scripts filled through them, but wife is still shaken and is now getting this filled locally. I hope that this mishap leads to some procedural changes at Amazon pharmacy. I can handle a 4k bite but that's definitely hard for most people. It's really a principle thing for me.
3
u/BluefaceBlues Nov 19 '25
Good suggestion, that is exactly what I just did. He made me feel somewhat confident about it, so we'll see how it plays out.
6
u/Head_of_Lettuce Nov 19 '25
Honestly that’s probably the worst thing you could’ve done in this situation. It doesn’t solve the problem, and you’re not likely to win the dispute. You need to address this with the insurance company, not the pharmacy. Ask them why they’re not covering the drug. It might be a simple fix. For example, you might need to use a specific specialty pharmacy that’s in-network with your insurance.
1
u/BluefaceBlues Nov 19 '25
Yes you're right, I replied to someone else with this:
Ok so apparently my wife was told that in order for her Dupixent orders to be covered by insurance, the pharmacy needs to be one that works with Accredo, a speciality pharmacy, and Amazon Pharmacy is apparently out of network in that regard.
1
u/Head_of_Lettuce Nov 20 '25 edited Nov 20 '25
That sucks. I take an expensive speciality medicine too, so I sympathize. It’s a gigantic pain in the ass to get these medicines covered, and sometimes you don’t realize things aren’t working as expected until it’s too late.
I think your best bet is to go to your insurance and ask them (firmly & politely) to make a 1 time exception and cover your last fill. Failing that, you can go to the manufacturer and ask them to extend you additional benefits to cover that last fill. If they won’t do that, you can ask them if they have any additional options to help you.
If your insurance is through you or your wife’s employer, you can try reaching out to your HR/benefits department for help. Most big employers have self-funded health insurance plans, so they have direct control over everything. If you explain the situation, they might be able to retroactively cover the last fill.
12
u/tenate Nov 19 '25
A chargeback will likely result in your amazon account being permanently closed, so make sure you get any data you want / need out of it asap.
3
-1
u/lalalalalavachicken Nov 20 '25
I'm in ireland 80 euro a month i pay
-1
u/Bakkie Nov 20 '25
And how does that help OP?
2
u/lalalalalavachicken Nov 20 '25
Sorry ur right im just flabbergasted at the price
-1
u/Bakkie Nov 20 '25
Agree.
Thanks for responding.
Your account has been credited with a unicorn point
0
u/missykins8472 Nov 19 '25
I’m going through the same thing with my son. They changed the program while we were re-enrolling (Dupixent my way program) when they said we no longer qualified. Our insurance does not cover it either. We are trying to figure out how to pay for it.
I would call Dupixent up personally and talk to a myway rep to see if you can enroll in their program.
0
0
u/burpinsoldier69 Nov 19 '25
Got my three month supple last week at Walmart and the cash price was $14k lol
-2
Nov 19 '25
Dispute with card company and return the meds
1
u/DigmonsDrill Nov 19 '25
It's doubtful the meds can be "returned" in any useful fashion.
2
u/onthedrug Nov 20 '25
No, its federally illegal for US pharmacies to accept any medications already dispersed.
2
-1
u/One-Training-7628 Nov 19 '25
transfer to an in-person pharmacy, i know walgreens can order dupixent
-2
u/No_Engineering6617 Nov 19 '25
switch the prescription back to your local pharmacy, that covers it. right away.
call your CC company and report the charges as fraud, you did Not authorize that charge (and that the def of fraud), then get that card they charged closed down. you will likely lose your amazon acct by doing so.
2
u/BluefaceBlues Nov 19 '25
Thanks, already in process of all that. Also, the card was my Prime Visa, so I literally won't need it if they close my account. Also we are filing an appeal with this insurance partner for them to cover it out of network.
-1
u/Defiant-Plankton-324 Nov 20 '25
IT'S AGAINST FEDERAL LAW FOR THE PHARMACY TO BILL100% OF THE COST TO A COMMERCIAL COPAY CARD..THEY ARE ARE ONLY ALLOWED TO BILL THAT CARD AS SECONDARY INSURANCE. IT'S NO SURPRISE AMAZON DOES NOT CATCH THIS..IF THEY GET AN HHS/ CMS AUDIT.. FILE A COMPLAINT WITH YOUR STATE PHARMACY BOARD, CMS AND TRY AND FIND OUT THE CONTACTS FOR AMAZON PHARMACY COMPLIANCE..THEY WOULD FIX IT FOR YOU I BET
1
u/BluefaceBlues Nov 20 '25
Can you share a link to the law you're referring to?
1
u/onthedrug Nov 20 '25
He can’t because there isn’t one. I work in this field. People pay with manufacture cards ALL the time. If that were the case then the copay card would have rejected as well.
1
u/Defiant-Plankton-324 Nov 21 '25 edited Nov 21 '25
They can only use the card if the commercial insurance pays first. In this case, the commercial insurance paid Zero, that is what makes the transaction fraudulent. Anyone can call the phone number to the specific pharmaceutical manufacturer program and ask them if they can use the card to pay 100% of the cost when their primary insurance pays Zero. If they go through an audit, the the transaction would be reversed.
1
u/Defiant-Plankton-324 Nov 21 '25
A pharmaceutical copay card that covers 100% of a patient's cost for a drug is illegal under the federal Anti-Kickback Statute (AKS)
50
u/Popular-Drummer-7989 Nov 19 '25
Some things are best left for human face to face conversation. Prescriptions of extreme cost are one of them. My person takes several and next year managing these will be tricky. Won't use a system that doesn't have a face attached to it.
Sorry this happened to you