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I never knew about this situation until now. Pt has birth control at copay of $15/month. One month later, it goes to non-formulary but is still covered at $40/month. I tell the pt. this info. And tell them that there is a list of birth control pills that are formulary for $15/month, contact your insurance company to find out and the doctor can switch you.
The pharmacists then suggests that the pt. can do a prior authorization to get the insurance to cover the medicine back to $15/month, since it is a pain to just switch birth control pills. In your experience, do you think the insurance would put a drug that they are already covering (as non-formulary) at $40/month back on formulary at $15/month if you try a prior authorization?
The pharmacists then suggests that the pt. can do a prior authorization to get the insurance to cover the medicine back to $15/month, since it is a pain to just switch birth control pills. In your experience, do you think the insurance would put a drug that they are already covering (as non-formulary) at $40/month back on formulary at $15/month if you try a prior authorization?
