Do pharmacy benefit companies need to give you notice for formulary changes?
I’m REALLY annoyed with my prescription insurance at the moment. I went to refill 3 medications about a week ago and the pharmacy had to order them. No big deal, that’s typical but it usually arrives in less than 24 hours. But because of the holiday it took forever (like 8 days) for it to arrive. I was in a panic this morning because I was really running low on all them and still wasn’t notified that they were in. Anyways, it arrived a few hours later and when the pharmacy went to run them through the insurance they receive rejections. All 3 are no longer covered. The cash price between the 3 is nearly $4,000 a month and the prior authorizations I had done for all them are worthless now, as the insurance needs formulary exception forms instead.
I called my prescription benefits company and they confirmed all the medications were dropped from the formulary beginning July 1st, so over a week ago. I complained that I never received any sort of notice about the changes and they said I should have received an email and/or letter, which I have not. I keep questioning how that it’s okay I never received their notice, and the representative just kept saying “well you did receive notice.” To top it, the formulary exception form will take at least 10-14 business days to receive approval. And even if it is approved, all will be the highest tiered medicines, so the most expensive. Previously they totaled $15 for a 90 day supply of all 3. I bet it would be no where near that price.
I just don’t get how this is allowed. And it’s not like they are new medicine for me, I’ve been all them for over 3 years without any insurances issues. It’s just frustrating and now I run the risk of running out of crucial medicines because I can’t afford that price for a single month.
And I checked manufacturer cards, there isn’t one for 1 medication as it’s a generic, and the other 2 require the insurance to cover it to use the coupon.
submitted by /u/Sad-Pay7593
[comments]
