Hi, I hope I’m not asking dumb questions here but I’m pretty confused. I have an Aetna standard plan (in NJ through my employer) which says they require prior authorization for certain medications. My Dr. prescribed one of those medications; Aetna sent me a letter saying it was approved, but at the pharmacy I find out (and later checking their website as well) that they will pay exactly $0 for it. The medication is on their formulary list (along with several other ADHD meds) and after using the pricing tool on their site it seems they will not pay for any of them, at least not the stimulants which is what my doctor recommends for me.
So is it just that my plan sucks, or is there something I’m missing here? I don’t understand why they have the drugs on their formulary and preapproved me just to have me pay the full cost myself (which is not cheap by the way).
Thanks. Again, I hope this isn’t a dumb question but insurance stuff really confuses me sometimes.
submitted by /u/magicalplaid
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Hi, I hope I’m not asking dumb questions here but I’m pretty confused. I have an Aetna standard plan (in NJ through my employer) which says they require prior authorization for certain medications. My Dr. prescribed one of those medications; Aetna sent me a letter saying it was approved, but at the pharmacy I find out (and later checking their website as well) that they will pay exactly $0 for it. The medication is on their formulary list (along with several other ADHD meds) and after using the pricing tool on their site it seems they will not pay for any of them, at least not the stimulants which is what my doctor recommends for me. So is it just that my plan sucks, or is there something I’m missing here? I don’t understand why they have the drugs on their formulary and preapproved me just to have me pay the full cost myself (which is not cheap by the way). Thanks. Again, I hope this isn’t a dumb question but insurance stuff really confuses me sometimes.
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