When you rely on costly prescriptions, few things are more alarming than learning your health insurance no longer covers it—and unfortunately, it happens more often than you may expect. According to new data from GoodRx, 15% of Americans have had at least one prescription dropped from their coverage over the past year. Luckily, Consumer Reports says there are steps you can take if this happens to you.
Talk to your pharmacist
You should start by speaking with your pharmacist to get the facts, and to see if they have any recommendations. You can double-check the pharmacy is in-network, your insurance information is up to date, and make sure they didn’t receive a duplicate prescription.
There are a couple of other options you may ask about: mail order or paying without insurance. Smaller, independent pharmacies may be willing to offer a lower cash price. You may also look for discount coupons through websites like BlinkHealth, GoodRx, or RxSaver.
Work with your insurer
Another option may be working with the insurance company. Your doctor may request an exception on your behalf; this process doesn’t happen immediately, though. If your insurance is through Healthcare.gov, see if your insurance company will offer a one-time refill to give your doctor more time.
You may work with a patient advocate. Consumer Reports says these professionals may charge $125 per hour or more, but it could pay off. You may check their credentials through the Patient Advocate Certification Board. If you have a Marketplace plan, try speaking with a local health insurance agent or broker.
You may also ask if your company is willing to advocate for you. Your HR plan administrator may have the ability to approve the prescription coverage or get it approved through the company’s broker.
If these options don’t work, you may file a formal appeal with the insurance company or an external review board. Your doctor should take the lead in this process by providing all the necessary documentation.
Seek financial assistance
After exhausting the steps above, there are a couple of final options. These options may not provide a long-term solution, but may offer some temporary relief until you figure out a better plan.
You may explore prescription assistance programs like needymeds.org or rxassist.org, which may offer income-based discounts. There may be a limit on how many prescriptions you can fill or how long you’re able to use the program, though.
You can also look for charitable pharmacies. There are 50 pharmacies and almost 700 charitable clinics with pharmacists throughout the country, and these places may offer free or discounted prescriptions.