Company changed providers from BCBS to UHC, UHC (Optum) won’t cover prescription. Any solutions?

Simple question without revealing too much PPI. Please redirect me if there is a more appropriate forum. I did not know what flair to choose.

I have been on a certain medication for ~20 years at a dosage of 400mg per day. Said medication is a Schedule IV controlled substance.

I have been on BCBS through my employer and said medication has always been approved for 400mg/day on a 90 day supply using generics (the maximum allowed by state law where I live without renewing the presciption.) Occasionally it is necessary to increase the dosage to 600mg for short durations as needed (PRN.) 200mg/day is widely ineffective at managing this particular medical condition and provides little or no benefit.

Effective April 1 our company's benefit coordinators switched us from BCBS to UHC. Along with much higher deductibles, increased OOP maximums, no coverage for my biannual cardiology exams, and 2-4x higher copays, the new plan uses UHC's "OptumRX" for prescription services.

My pharmacy whom I have been with for the same 20+ years advises me that UHC/Optum will only approve my prescription at half dosage (200mg/day) and is refusing to honor the prescription for 400mg/day. The stated reason is that the medication is "not covered at dosages above 200 mg/day." There are no alternative medications available for this particular condition, so it's not like I can just change to a different medicine.

I contacted my doctor and she states that there is nothing she can do to assist with this issue, and she is refusing to do anything at all to try to help me resolve the concern. Her office only responds via nurses/assistants via the patient portal. She is seemingly unable or unwilling to help me in any way or to advocate on my behalf with UHC.

This puts me in a very rough situation as I have now been off said medication for 2+ weeks and it is greatly affecting many aspects of my life, but Optum is refusing to budge on this issue.

Are there any legal or medical options by which I might be able to compel or otherwise force Optum to both honor and comply with my medication prescription at its original prescribed and intended dose? Are they required to "grandfather in" my previous prescription in some way? Would my company's HR department/benefits coordinator be able to force OptumRX to comply with the prescription as written via some avenue?

Again, please let me know if this is not the appropriate venue for this sort of question.

submitted by /u/paralyse78
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