UHC Tier 3 Medication not on RX Formulary of new UHC Insurance Plan

Hello,

My employer has entered into a contract with a third party HR provider who in turn has a contract with UHC and is giving us a couple of plans to choose from.

I have been on HRT medication for the past several years using Combipatch which has no generic. This medication is listed as Tier 3 on my current UHC insurance which expires tomorrow (I am currently paying $188 for a 3 month supply). I have just been informed none of the insurance plans, all UHC, available to me contracted by this third party have Combipatch on the RX formulary at all.

I was told the very best case scenario would be that the medication could potentially become a Tier 4 medication with a prior authorization from the physician at $250/mo copay. Otherwise, it would not be covered at all and it retails in the neighborhood of $400/mo.

I don’t know much at all about insurance, my current coverage through my employer became effective in May which is the beginning of our calendar year and it is terminating tomorrow. The new coverage is set to begin August 1st.

What are my options, if any? Could this sudden change in insurance be considered a qualifying life event where I could explore the option of joining my husband’s insurace through his employer?

Thank you for taking the time to read this and for any input.

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