forced to use mail-order pharmacy

[drummergirl0903]

I live and work in Northern Virginia. My company requires with my medical benefits that for long-term medication employees only use mail-order services provided by our insurance carrier. If we choose to go to a retail pharmacy after 3 months of medication our benefits will be denied and the expense must be paid out of pocket. While I understand, and potentially agree with, the financial savings that I (I guess) and definitely my employer receives using this method, it is causing major problems.

I am on certain pyshciatric medications that are likely to change frequently, both in dosage and type. I don't always need the full 3 months worth of medication dispensed by the mail-order company as my meds could change, and have run out of meds on several occasions waiting for them to be filled and mailed to me by the mail-order company. Having to abruptly cease these meds, or figure out a way to get just enough to get me by until they arrive in the mail, is dangerous. It's not like these are allergies pills and at worst I'll have hayfever for a few days. These are brain-altering drugs for a diagnosed and recognized medical condition!

I've asked my employer if there is any way to not use the mail order due to these issues and have repeatedly been told that exceptions are not allowed, no matter what. Is there any recourse for me to be able to convince my employer to let me use my benefits and a retail pharmacy?

 

[cbg]

Your employer undoubtably has a contract with the insurance carrier regarding the use of their mail order program. If this is the case, the employer does not have the option of simply making an exception for you since they would be in violation of the contract with the carrier to do so.

That being the case, no, I don't see any way you can legally force them to allow you to use a retail pharmacy.

 

[grasmicc]

Basically this has nothing to do with your company, and everything to do with the insurance carrier and their pharmacy.

That being said, depending on factors not listed here, you could try to force the insurance provider to let you use a local pharmacy. Contact them directly and be prepared to have your physician talk to them directly if necessary.

If it came down to it, I can see several ways you could legally force the insurance provider to let you use a local pharmacy. That being said, it would be impractical under these circumstances to try to litigate (probably arbitrate under the insurance contract) such an issue. Just contact the insurance carrier directly.