Here’s PART TWO: Affordable Meds in our series we call . . .
“The Insurance Mom’s Guide to Better Living
Through (Cheaper) Chemistry”
You’ve followed PART ONE and you understand how your plan works and the formulary (aka list of drugs your insurance company covers.) Now what if your drug isn’t in the formulary??
I get lots of calls from people complaining their drugs were in the formulary and now they’re not. Drugs get dropped from formularies all the time. Check out this article on the 50+ drugs dropped from insurance in 2016.
Get mad, punch a pillow, and then use some of the following suggestions to get your plan to work for you. If you’re lost or need advice, call The Insurance Mom for a hug, a chicken soup recipe, and some morale-boosting information!
PART TWO: FIGHT FOR YOUR RIGHTS TO AFFORDABLE MEDS!
Advocate! If your drug is dropped from the formulary, ask your doctor if there are other Rx alternatives. And then check with your insurance company to see if they’re in the formulary.
Get Squeaky! If your doc says, “nope, sorry, you need THIS exact drug,” tell the doctor’s office to call your insurance company to get a Prior Authorization. It’s time to be a squeaky wheel!
Squeak Some More! If the Prior Authorization doesn’t work, ask the doctor’s office to help you file an Expedited Appeal. Remember to tell the doctor when you ask for the Prior Authorization that this second step may be next. The doctor should be able to file the Expedited Appeal during the same phone call to your insurance company. Save time by telling them upfront! And hurry up and wait . . . this process can take a while. Click this hyperlink for more tips on filing for an appeal.
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