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Being forced into mailer order perscriptions
Jan 20, 2014

I an employed by a NY company but live in another state. Recently i was denised my antiviral perscription renewal, even though my Insurance Provider hasn't changed, and told that the med could only be ordered through mail delivery and that it would take 48 hours for the approval and another 7 to 10 business days for the actual delviery. When I mentioned that I was nearly out of medication, and even after my Dr. called and told the Insurance Company that they were putting my health at risk, they said they would submit an overide request and that any such over ride would take 3 business days and that basically I'd have to find my own meds and pay full price for them until they approved and fulfilled my perscription. Meanwhile the local pharmacy didn't want to agree to provide a few days worth of meds. After a full melt down in the pharmacy they agreed to give me 3 days.

I guess my questions is . .. .can I be forced into the mail order only option. Is the NY law or the employee or does it apply to the address of the patient? Also, I'm nearly out of medicine again and I have no hope that CVS Caremark will be able to straighten this out anytime soon. Is there any advice on how to get medicine while they are working through their approval processes (even though I've had CVS Caremark for years.)?

Response from Mr. Chambers

In 2012, New York enacted a law prohibiting Pharmacy Benefit Managers (PBMs) from requiring insured people to buy their medications through mail order.

According to the attached article, some last minute amendments may have reduced the law's impact.

Check with a local HIV pharmacy and/or clinic as they will be able to tell you whether that law will help you in your situation. attached article,

Good luck, Jacques



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