Health Insurance Consumer Guide

What if my plan no longer covers my prescription?

What do I do if I’m at the pharmacy to pick up my prescription, and they said my plan no longer covers it?

Some insurance companies may provide a one-time refill for your medication after you first enroll. Ask your insurance company if they offer a one-time refill until you can discuss next steps with your doctor.

If you can’t get a one-time refill, you have the right to follow your insurance company’s drug exceptions process, which allows you to get a prescribed drug that’s not normally covered by your health plan. Because the details of every plan’s exceptions process are different, you should contact your insurance company for more information.

Generally, to get your drug covered through the exceptions process, your doctor must confirm to your health plan (verbally or in writing) that the drug is appropriate for your medical condition based on one or more of the following: