Pharmaceutical Monopoly??

[faithremoved]

What is the name of your state? Illinois
With the new health insurance my company provides, it is a REQUIREMENT that all maintenance medications ie birth control, allergy medication etc... go through the insurance company via mail order. Is this legal? I feel as though my freedom of choice has been taken away.
Is there a measurement available to explain how the tier levels of prescription medications are determined? One of my prescriptions was a tier one and the next thing I knew when I received my bill, it shot up to a tier three and my copay tripled. Is there a legal guideline or can insurance companies just change the tier level once a drug has become "popular"?

I look forward to any/all responses.

Thank you!

[Silverplum]

Originally Posted by faithremoved

What is the name of your state? Illinois
With the new health insurance my company provides, it is a REQUIREMENT that all maintenance medications ie birth control, allergy medication etc... go through the insurance company via mail order. Is this legal? I feel as though my freedom of choice has been taken away.

WHAT "freedom of choice?"
Where does the US Constitution provide for "freedom of choice?"

[faithremoved]

So you don't see it as a monopoly of some sort?

[justalayman]

You have a choice.

buy the meds where your insurance company will pick up the tab

or;

pay the entire amount for the meds at whatever pharm you choose.

There is your choice.

[Silverplum]

Originally Posted by faithremoved

So you don't see it as a monopoly of some sort?

No. And you didn't answer my question.

[ecmst12]

It's cheaper to get maintenence meds through mail order anyway, not to mention more convenient, why would you complain? Because you WANT to drive to the pharmacy every month and pay more money?

Tier one is usually generic medicines. Sounds like they filled your prescription with brand instead of generic, and the brand was not in the formulary. Call the pharmacy and ask why they filled it with brand name instead, did your physician check off "brand necessary" on the script? Tier 2 is brands in the formulary, meaning your insurance company has a deal with the manufacturer for a discounted rate. They pass their savings on to you.

[faithremoved]

Originally Posted by Silverplum

No. And you didn't answer my question.

You're right, and I apologize for not answering your question. I guess as an american, I think we should have the freedom of choice to shop for our meds anywhere I want but apparently not. The choice I have made is to get the meds from somewhere else and not go through the insurance because it is cheaper.

ecmst12, the prescription was the exact same (not generic) and went from a tier one to a tier three. Mail order may be more convenient for you, but it is not for me. I like to be in control and know when I am going to receive my meds and not have to depend on the US Post Office or any other carrier to get them to me in the timeframe required.

Based on the responses I have received, I guess "it is what it is". I know that I am not alone when I say I am paying higher premiums and paying higher co-pays, it is just getting tougher for me to "get by".

Thank you for your responses.

[cbg]

You do have the choice of going anywhere you want and buying the presriptions anywhere you want to go. No one is stopping you from doing so.

It's simply that the insurance carrier will only pick up the tab if you follow their rules.

You are free to go anywhere you like, get the prescriptions anywhere you want, and pay for them yourself.

[TIMMAAYY]

Typically you get three months of prescription for two months of cost with mail order.

However, the programs from Walmart, Meijer, Target, etc, where generic is available, are much better options. For $4 a fill, it's hard to beat that.... if it's available.

Also, the formularies for each carrier change quite often. One month your drug might be on it, the next month it might not be.

As far as them "requiring" you to use mail order in order for them to pay for it, yes, they can. With all of my groups I recommend to ALL of those with maintenence precriptions to get them mail order. It's less expensive, and once you are on a regular cycle ( first order ) it's no hassle at all.