Helping 20 Million Americans a Year for 20 Years. FREE!
Find the Right Lawyer for Your Legal Issue!

Find the Right Lawyer for Your Legal Issue!

Fast, Free, and Confidential

Call us today for a free consultation (855) 466-5776

Can my employer provided pharmacy management company legally refuse to cover my medicine?

Question Details: At the first of the year, my employer provided health insurance pharmacy manager notified me that they were removing my medication from the formulary for this year. I have been taking the name brand medication for years now. Recently, I took a 30 day round of the generic they wanted to switch me to. It did not work anywhere close to being as good as the name brand, which is why the doctor put me on the name brand to begin with. A few weeks later, I am still trying to get over the consequences of taking the generic as opposed to the name brand. To date, the doctor has submitted 2 prior authorizations, both reviewed and denied. Then, the reviews were escalated to an appeal, also denied. The reason, not meeting medical criteria for the plan, which usually translates to "not medically necessary". I am in extreme pain without the name brand, unable to function quality of life, and being without it will greatly impact my ability to to my job. Is this legal or discrimination? If legal, why are they allowed to get away with this?

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.