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Dear Addy: Choice in Health Care

Dear Addy

Dear Addy,

I am frustrated because my insurance company has mandated that its members use a single pharmacy provider. What can be done to stop this denial of choice?

Signed,

Pharmacy Frustrated<

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Dear Frustrated,

Health insurance providers are making this change as a cost savings measure. In order to keep their costs down, and ultimately yours, insurers are using pharmacy providers who can offer them the best price for medications and services. If you find that the pharmacy to which you are switched cannot meet your needs, advise your insurance company about the holes in their service. Ask if you can use a different pharmacy, perhaps the one you have used for a long time. You must have legitimate reasons for the exception. Make a list, present it calmly to the right person at your insurer, enlist the help of your human resources representative at your company, and keep a record of all your correspondence, phone calls, and any other types of communications with your insurer about this issue.

Should your insurer advise you that the switch is permanent but you feel that your needs cannot be met by the new pharmacy, file an appeal of the decision with your insurer. Let HFA know about your filing and the result so that we can use this information to help others in your situation.

Ultimately, if you cannot switch back to your old pharmacy, you may need to educate your new pharmacy about your bleeding disorder, your requirement for quick delivery of factor, and other specific needs you have. You can find helpful information to share with your new pharmacy on the HFA website.

Sincerely,

Addy

Have a question? Click HERE. Your name will be changed in the response.

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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.

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