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Insurance question
Oct 31, 2012

I take Atripla and my group insurance has moved this drug from preventive to non preventive, this will increase mu out of pocket expense. My question is are they able to make this change?

Response from Mr. Chambers

in virtually all states, insurance companies are allowed to develop and revise their formulary of medications and assign the Tier which determines the copay you must pay.

However, dividing the medications into classifications like preventive and non-preventive is unfamiliar to me. You may want to investigate this further by talking it over with your doctor and asking the carrier how they determine what drugs are preventive or non preventive.

If it seems arbitrary or if you discover this class seems to be applied only to HIV medications, you may want to ask your state's Department of Insurance to look into it.

Good luck, Jacques



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