Hello, I have a question and I am pretty sure a lot of people would like to have an answer too. Is it leagal for an insurance company to override a physician' s prescription? My neurologist write my MS treatment prescription for a 90 supply and it's been delivered this way since I was diagnosed 10 years ago. Starting this year, January 2020, my insurance's policy changed and I am only allowed to get a 30 days supply at a time. This is very challenging since I can travel for work and also have elderly parents abroad. The medicine cannot be shipped in a foreign country. If I have to leave in emergency from the USA and my supply is low (I am not allowed to pre-order in advance either), it means I cannot leave the country. So, basically, they are keeping patients even more ostages of their disease than they already are. This makes me furious, any comments or similars experiences out there?
I think it is somewhat common, unfortunately, for insurance plans to use quantity limits. You can try appealing or requesting an exception to this, with your neurologist's assistance. There may be a specific process or certain forms you would need to use - contact your plan directly to find out what they need. Your neurologist may need to provide more detailed information about your health and your need for a 90 day supply.
These are some links that may have some helpful guidance for this, but the exact process for an exception will depend on your specific plan:
I hope this helps!
When travelling in the USA bring the bottle with you when you travel you can go into any pharmacy and have the prescription TRANSFERRED, they will refill the script, and when you get back home you can re-transfer the script.
Yes I had the same issue a few years back, and my neurologist recommended RX Outreach. And now I get my modafinil with a 90 day supply for only $80 through them. And my insurance, at the time, as I don't have any right now, wanted to charge $200+
for the same amount. Even with insurance, RX Outreach is amazing.
RX options is another prescription assistance program, that is very helpful. Good luck