My medication not covered under insurance?

Question

I am on Lexapro, and have just found out that my new Insurance plan does not cover lexapro when I was told by my pharmacists that it was. How can I go about getting Lexapro covered? What do I or my doctor need to do?

From what I read Lexapro is considered a "safety step medication." I must first prove that I have tried one of the drugs on their preferred list and that it didn't work for me before lexapro can be covered. I have done that already two months ago. My doctor prescribed me Prozac. I stayed on 1 month and had problems. He then put me back on Lexapro. Would that constitute a change needed? It says that if Lexapro is medically required I would receive a grant. Should this be an easy thing for my doctor to get done?

Answer 1

Try other prescription cards out there on the market
place that work better for Lexapro.

Answer 2

The MD or his office staff have to fill out forms required by the insurance company. They are a pain in the neck...I know, I've filled plenty of them out....but if the MD has proof in your chart that you have been unsuccessfully treated with other meds they should grant you an exception. They may require a trial of more than just Prozac though. In the mean time you suffer if that medication does not work. Try to work with them though. There are plenty of other medications similar to Lexapro that your insurance company does cover and if they do work then the insurance companies and you save money in the long run.
Many drug companies also offer free medications to patients that can't afford their prescriptions. Your MD should have that information as well. If they don't, ask at the pharmacy.

Answer 3

well there is always the option of trying another medication, however is you have tried and failed other medications for your condition, your drs office can prior authorize the medication through your insurance. The doctor can send your insurance company a letter of medical necessity that the dr feels strongly that you need to continue with this medication. hope everything works out for ya. and also, lexapro (since it has no generic at this time) is sampled in most drs offices. And usually, if you keep up to date with appts and bloodwork, the dr should have no problem trying to supply you with samples when they come into the office. i work in a drs office, and we always have free samples of lexapro to give to pts. and if worse comes to worse you can pay out of pocket for the lexapro, but im sure its pretty pricey. hope i was a help to you, good luck :)

Answer 4

Two suggestions: Keep trying to get your insurance to cover it. I sympathize...I can't tolerate prozac, but Lexapro helps a lot. Second, the drug companies do have programs to assist. Check out http://www.rxassist.org/. Good luck!

Answer 5

Call your insurance company and see if something has to be submitted on their form and if so, get one and take it to your doctor's office to be completed. If the doctor can do a memo or something ask what needs to be on his letter so that you can get your medication quickly as possible. Also you may try calling Wal-Mart and see if it is on their $4.00 approved medicine list. Ask that they call you (or whatever) when it is filled out so that you can get it to your insurance company. This way you will know when it was sent, faxed to them e-mailed. I would get a person's name at the insurance company and send it to their attention so you can follow up to make sure it is received by them. Chances are, your doctor has already had to do that type of thing for someone else because their insurance company either changed policies or another one was chosen as the company insurance.

Answer 6

You'll probably need prior authorization. Depending on your insurance, that can take a long time. Contact your insurance, and see what is their appeal procedure. My guess is that you'll need a note from your doctor stating that prozac did not work.
Lexapro is not a preferred drug because it is still on patent.

Answer 7

You know you could always ask your Dr. for samples since its not covered on your insurance.....
You know they get samples of Drugs all the time......
I have a Dr. who tries to keep up on what is & isn't being covered & provides samples when they aren't....
Dealing with Ins. co. over Rx's can be a real headace...To put it nicely....

Answer 8

It probably is a matter of getting the meds approved by your new insurance. The doctor will have to contact them to get them to approve it.

Answer 9

i'm sure if you talk with a pharmisict they can help. they deal with people with no coverage daily and i'm sure they can give you rescources and options.

Answer 10

cymbalta