Prescription Drug Coverage Runaround

My health insurance is a self-funded plan through my husband's employer & managed by Highmark BCBS and Express Scripts in Minnesota. I'm getting conflicting information from them about where I have to purchase my maintenance medications and need help.

I take a medication that has no generic available, required step therapy to be on, and needed a prior authorization for, which I got. I bought it locally at a pharmacy for two months & was able to use a manufacturer's co-pay assistance program. to reduce my out of pocket costs. After two months, I was notified by Express Scripts that I had to get the medication via their mail order pharmacy from now on since it is a maintenance medication & that they don't accept manufacturer's co-pay programs. So now I have to pay the full co-pay for the drug.

Yet, according to the Express Scripts & Highmark BCBS websites, I should be able to get a 90 day supply locally at select retail pharmacies for the same co-pay price at mail order, which would mean I could use a manufacturer's co-pay program again. I sent a message to customer service on Express Scripts and the rep confirmed this a couple of days ago.

Today, I get a message from them saying that isn't the case. I have to go through the mail order pharmacy and there is no local retail option. Yet I was told there was and the website still says that I can do that. I've got screenshots of it.

So what am I supposed to do when I get conflicting information from them about my benefits? I'm trying to make sure I go to in-network doctors, pharmacies, and get pre-approvals according to the plan documents we got & that are online, yet those are not definitive? So what is? How do I get to the bottom of things and make sure I'm staying within network if I can't get a straight answer from anyone at Highmark BCBS or at Express Scripts?

submitted by /u/tangodream
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