I’ve been taking a new drug for my asthma and it’s working beautifully. When I went to get it filled last time, the drug store told me it wasn’t covered any more. Can a health plan stop covering a medicine in the middle of the year? What am I supposed to do?
Yes the plan can stop covering a drug in mid-year though it should still cover something comparable or cover your medicine with a higher co-pay. Before you switch to another medicine, find out if the plan will still cover your medicine with a prior authorization. Your doctor would submit information to the plan and the plan would decide whether to approve it. If they decide not to approve it, you can appeal their decision. “Appeal” means that you ask them to reconsider it.
If the drug is simply no longer covered and the other options are not appropriate for you, go to the drug manufacturer’s website and look for their patient assistance program. Some manufacturers will give you a steep discount on the medicine, if you qualify.