Medical Mutual not covering prescriptions

My employer changed to medical mutual for insurance July 1. I have had constant problems with them and am on the phone with them at least once a week.

Today I went to the pharmacy to pick up my prescriptions (I take them everyday) and was told by the pharmacist that insurance will not take it. She even tried codes to bring the prices down the no avail. I went home and called them and they let me know that with the plan I have that after 90 days they do not cover any prescriptions. Now if I want to get any of my prescription (I take about 5-6 different ones daily) they will be at least $300 each.

Like honestly? I have never heard of insurance doing that. Has anyone ever had this?

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Are you sure they didn’t say they would refill maintenance meds at a local pharmacy for up to 90 days, and after that, you’d need to use mail order for 90-day supplies? (That usually saves you money.)

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Definitely worth asking about this. It’s fairly common now to require mail order for maintenance meds after the first 90 days.

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This sounds more accurate than the plan not covering them at all.

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Yes, check your Summary of Benefits

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I don’t understand why your employer would choose a plan without outpatient drug coverage in 2024. These plans used to be common, but as drug costs rose, insurance started covering them. While insurance coverage has driven drug prices higher, that doesn’t help you now. If getting an ACA plan isn’t an option, sign up for as many drug discount and assistance programs as possible. Your State Health Insurance Program staff might be able to help you with this.

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This is not a real insurance plan

Make sure you buy your plan through the ACA exchange

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Medical Mutual is a real insurance company and one of the largest in Ohio. It covers a significant number of employer groups in the state.

I think you might need to use mail order for your maintenance meds and misunderstood what the pharmacy explained. I suggest reviewing your plan documents or talking with your benefits representative to understand how your prescription coverage works. Good luck!

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If it’s a mail order requirement, the rejection will say that. I will tell the patient directly what the issue is

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In the original post, she mentioned, “after 90 days they don’t cover any prescriptions,” which sounds like she misunderstood what the pharmacy explained. I could be wrong, but I can’t see a situation where a policy covers prescriptions for only the first 90 days and then stops completely.

It’s common to cover prescriptions for the first 90 days at the pharmacy and then require mail order. It’s also possible to cover the first 90 days without prior authorization when a group changes carriers, giving providers time to request authorization with the new plan. However, having prescriptions only covered for the first 90 days and then not at all seems much less likely than those two scenarios.