insurance companies determining treatments and medication choices is no favor
I was not particularly surprised to see the increases in monthly premiums for the AARP sponsored health insurance packages, but I was disgusted to receive my 'personalized' notice that my medications were no longer going to be covered as in the past. What is it that has inured us to insurance companies deciding what is and is not acceptable treatment or medication based on their ability/inability to make a profitable deal with drug companies? The company was kind enough to send me their recommended alternatives, both of which I tried and both of which created unacceptable side effects. I suppose that is nothing compared to the consideration of corporate profits. I consider my doctor to be the one to provide the best alternatives in treatment for health issues. We're long past due to complain long and loud until this practice by insurance companies is halted.
I will try to explain how the Medicare Part D plans work (Medicare Prescription Drug Coverage).
These type plans can be purchased as free-standing plans OR they can be within some Medicare Advantage plans. Either way, these plans should be evaluated by the beneficiary each year based on your individual needs during open enrollment. Medications change for the beneficiary as well as on the insurers formulary.
The Medicare Part D insurers mustcover a select number of medication in each drug classification and in (5) classes they have to cover ALL of them. Each year they develop their formulary (list of the drugs they cover) including assignment of the tiers (price level) of the drugs.
They also assign any special circumstances to certain drugs for safety or cost control reasons like Quantity Limits, Step Therapy, Prior Approval and list these on their formulary.
If one insurer doesn't cover what medication you need - as long as it is approved for seniors - another plan should probably have it in their formulary. Shop your plan during open enrollment
(October 15 – December 7, 2020).
That's why they are making suggestions to you (and your doctor), i.e. we aren't covering this med that you take but we are covering this other one that may suit your needs. There may be other circumstances why medications change even during the year - a drug that enters the generic market, a drug that is removed because of an FDA ruling,
If you and your doc are sold on one particular med, check other insurers in your area and change plans before open enrollment ends. You also have the right to file an appeal or ask for an exception.