We have all struggled during that long line at the pharmacy counter. What will be covered? What won’t be? How much will you pay out of pocket? Will you have to try other drugs first to get this one to go through your insurance? And if it all goes sideways–what are you supposed to do to fix it?
Janssen Pharma has created a helpful and necessary guide on these important questions that all patients have.
Sometimes you may not be able to obtain a prescription medication that your healthcare provider (prescriber) has ordered for you. For example, your health plan might not cover the drug because it is not on the plan’s drug list (formulary), or the cost is higher than you think you should have to pay.
In these situations, you and your prescriber have the right to ask the health plan to explain its decision and to consider making the drug available to you as an exception to its policies. Exception requests are common processes for prescription drug plans, especially when medicines enter the market and they are not on your plan’s list of covered drugs. This guide has been developed to help you understand:
• What priorauthorization?
• How to request an exception
• How to appeal if the exception request is denied
Read the entire guide here: Exceptions and Appeals