Does a plan have to provide a formulary on request?
I have a chronic condition that has dozens of medication options. I’m talking with a doctor about switching to a new medication. I want to see the formulary for my insurance. I requested it from the PBM (Express Scripts) and they said I had to ask the insurance company. The insurance company sent me back to Express Scripts. I called my employer’s HR. They transferred me to Express Scripts. They again told me that a formulary exists but I could not access it. They told me to search each individual drug on the site to see its coverage. This is not useful because I want to work with the doctor to pick the best option out of the ones that are covered/affordable. It would also be ideal if I could have the policies for PA and step therapy. When I search an individual drug, it will say that it requires a prior authorization or step therapy, but it doesn’t say or link to anything specific about requirements. Are they really allowed to refuse to even let me know what is covered?
