Will insurer / PBM still honor prior authorization if drug is removed from formulary?

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State: Florida

I had a prior authorization request approved in September for a certain drug. When I went to renew my coverage on Healthcare.gov, I noticed that my insurer / PBM no longer lists that drug on my current formulary and my 2021 formulary.

I called my PBM to verify whether that drug would still be covered for me, even if it was no longer listed as a covered drug. The representative said that it would still be covered for the duration of the prior authorization (until September 2021), but honestly I am quite skeptical (these representatives, while I’m sure they try their best, can sometimes make mistakes). I plan to call again tomorrow to double-check with another representative to see whether he was correct.

Does anyone else have experience with this issue? Do insurers typically honor prior authorizations in such cases? Do I have good reason to be skeptical?

The insurer is Blue Cross Blue Shield of Florida (FloridaBlue); the PBM is Prime Therapeutics. To be clear, they do cover an alternative drug for the same purpose, but I have never tried it and would have to submit another prior authorization request (which, for obvious reasons, I would rather not have to do).

submitted by /u/Xiaolingtong
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State: Florida I had a prior authorization request approved in September for a certain drug. When I went to renew my coverage on Healthcare.gov, I noticed that my insurer / PBM no longer lists that drug on my current formulary and my 2021 formulary. I called my PBM to verify whether that drug would still be covered for me, even if it was no longer listed as a covered drug. The representative said that it would still be covered for the duration of the prior authorization (until September 2021), but honestly I am quite skeptical (these representatives, while I’m sure they try their best, can sometimes make mistakes). I plan to call again tomorrow to double-check with another representative to see whether he was correct. Does anyone else have experience with this issue? Do insurers typically honor prior authorizations in such cases? Do I have good reason to be skeptical? The insurer is Blue Cross Blue Shield of Florida (FloridaBlue); the PBM is Prime Therapeutics. To be clear, they do cover an alternative drug for the same purpose, but I have never tried it and would have to submit another prior authorization request (which, for obvious reasons, I would rather not have to do).
submitted by /u/Xiaolingtong [link] [comments]Read Morer/HealthInsurance

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