Spud
Expert
- 93
Hi, are you aware of any plans/companies that consistently (have a policy?) to deny all appeals for coverage of a prescription med (on the CMS formulary but not on the plan's formulary)?
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I get that, but should be one off situation. I rarely have this issue come up. I usually discuss with the client that every drug plan has to cover at minimum 2 drugs in every therapeutic category, most cover quite a few. What is the medicine? Is it a pain medicine? Those are usually the medicines that PDP companies don't budge on formulary exception.med's can be prescribed during the plan year (after plan selection)...this is the issue.
I get that, but should be one off situation. I rarely have this issue come up. I usually discuss with the client that every drug plan has to cover at minimum 2 drugs in every therapeutic category, most cover quite a few. What is the medicine? Is it a pain medicine? Those are usually the medicines that PDP companies don't budge on formulary exception.