Insurance denied coverage, but I just received word from the pharmacy that I still got a $30 copay???

I requested my PCP to prescribe me Mounjaro (due to PCOS, no T2D diagnosis) on 6/20. She did, and the Prior Authorization process has been going on for nearly two weeks now.

CVS messaged me saying “Rx is pending insurance approval” on 6/20. Then I received the message “We are contacting your prescriber for an alternative medicine” on 6/26. On 6/27, I got the “Rx is pending insurance approval” again.

I got a call from my doctor’s office on 6/28, informing me that insurance denied my coverage, I should receive a letter in the mail soon, and that I should speak to my PCP for other medication options.

THEN, on 6/30 CVS messages me that “Rx is out of stock, but on order”. Called the pharmacy, TWICE, and had two different pharmacists tell me that insurance would cover it and I would have a $30 copay. But today, (7/1) I just found that 6/26 letter from Express Scripts saying my coverage was denied because of the lack of T2D.

Sorry if this is too much, I’m just confused?? I’ve heard other stories about people who were told that they were denied coverage, but then got their first refill covered (almost like a courtesy refill). Is that what this was? The Rx is supposed to be available on Monday, so I’ll check and make sure that copay amount is actually correct. Do you guys think the insurance company may have at some point reversed their decision during 6/26 – 6/30?

I do plan on calling my insurance (I have BCBS MA) next week to see what’s going on. I just wanted to know if anyone else has experienced something like this.

submitted by /u/Left-Reply-4979
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