Insurance Letter: “Your Medicine Is No Longer Covered”

Published January 24, 2024

Insurance companies have a list of medicines, called a formulary, which are part of their prescription plan. The medicines that are on this list usually cost less for their members than other medicines not on the list. Occasionally, the insurance company may update the list of medicines that are covered on their formulary to reduce cost. This is often done at the beginning of the year. If your company will no longer cover the medicine you take, they will send you a letter in the mail. Usually, the letter will include a list of similar medicines that they cover that can replace the medicine you take. However, some people may not understand what this letter means and ignore it. Then when it is time to refill their prescription, they may be told the prescription costs hundreds of dollars instead of what they previously had to pay.

  Doctors and pharmacists do not receive insurance notifications that your medicine is no longer covered. Also, they would not know which medicines are covered and which are not, since each insurance company has a different formulary. Therefore, it is important for you to contact your doctor as soon as you receive the notice from your insurance company about a change in coverage. This will help prevent treatment interruptions or delays.

If the insurance letter you receive does not indicate which alternative medicine(s) would be covered, then your doctor will need to communicate with your pharmacy and/or insurance company to find a covered medicine that is similar to what you are taking. If your doctor decides that your current prescription should not be switched, then your doctor will have to contact your insurance company to try to get your current medicine approved, which may take a while.    

Here’s what you can do: If you receive a letter from your insurance company about changes to medicines they will cover, consider the following: 

• Inform your doctor about your insurance notification letter. It is important to do this as soon as possible to prevent a delay in treatment. Let your doctor know how much medicine you currently have or when you are due for a refill. You may need to schedule an appointment with your doctor to discuss this change and to determine which medicine will work best to treat your condition. In the meantime, keep taking your current medicines as prescribed until you are switched to the new medicine.
• Once switched, do not take the old medication. Ask your doctor if you should continue taking the old medicine until it is used up before starting the new medicine, or if you should stop taking it and start the new medicine right away. If you start the new medicine before the old supply is finished, make sure you dispose of your old medicine immediately.  
• Talk with your pharmacist. If a new medicine is prescribed, ask to speak to the pharmacist when you pick up the medicine at the pharmacy. Your pharmacist will make sure the new medicine does not interact with any other medicines you take. Make sure the pharmacist knows all over-the-counter medicines and supplements you take to ensure they will not interact with the new medicine. Your pharmacist will be able to explain how to take the new medicine and what side effects you may experience. In addition, they can explain what to do with the old medicine you have and answer any questions.
• Keep follow-up appointments with your doctor. Your doctor may need to schedule a follow-up visit or order blood work to make sure the new medicine is working well to treat your condition. 

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