My Insurance Coverage Changed or Dropped: What Now?

Prescription Drugs

My Insurance Coverage Changed or Dropped: What Now?

Health Insurance
RxSaver Editors
By RxSaver Editors
Aug 24, 2016 - Updated Jan 13, 2021
Pills pouring out of a pill bottle

Each new year, insurance companies release a list of medications they will cover. This list is known as an insurance formulary. You can typically view the list of medications your insurance will cover by visiting your insurance company’s website.

Unfortunately, you may find that your insurance company has decided to no longer cover one or more of your prescriptions. While finding out that a necessary medication may no longer be covered can be stressful, there are things you can do.

Here are 8 things to know if your health insurance drops your prescription, including ways to save money using prescription medication coupons from RxSaver.

Use the RxSaver tool below to search discounted coupons at nearby pharmacies.

Why did my insurance stop covering my prescription?

Insurance companies determine which prescriptions they will cover typically based on the recommendation of a team of health care providers and pharmacists. Medications may be dropped from insurance formularies for a variety of reasons including:

  • A generic medication is now available, and cheaper than the brand drug
  • The drug is deemed to be less effective than other similar drugs
  • The drug is more expensive than others, but not necessarily more effective than similar medications available

What can you do if your prescription is dropped?

If your insurance has dropped your medication from their list of covered medications, don’t panic. You have options, which include:

  • Request an exception from your insurance company.
  • Use RxSaver prescription drug coupons
  • Request a generic alternative medication
  • Shop for the best prices from multiple pharmacies
  • Look for manufacturer coupons or savings programs

Request an Exception from Your Insurance Company

Insurance companies grant exceptions. If your prescription medication is dropped, you may request an exception, so that it is covered. For an exception for your medication to be considered your health care provider must confirm:

  • You need the prescribed drug
  • Drugs that are covered by your insurance won’t be as effective as the prescribed drug
  • Drugs that are covered by your insurance may actually harm you
  • You need a higher dose of the medication than is available from your insurance

Your insurance may deny your exception request. If they deny the exception, you are entitled to file an appeal. Your insurance company must then explain why they have denied the exception, and you may request a complete review of the denial process to ensure that the review has been complete and fair.

Use RxSaver

RxSaver is a free prescription drug coupon platform. It can be used in place of insurance, or if you don’t have insurance. RxSaver offers savings of up to 85% on more than 6,000 medications. You do not need to become a member, and there are never any fees for using RxSaver.

Simply go to the RxSaver website or free RxSaver app and type in your prescription in the search bar on the RxSaver app. You’ll immediately find pricing for your medication at various pharmacies near you.

Request a Generic Alternative

Many brand drugs have generic equivalents. Generic medications are significantly cheaper than brand drugs but contain the same active ingredients. This means they work the same way the brand drug works.

Shop Pharmacies for the Best Prescription Price

If your insurance has dropped a prescription you need, be sure to shop at various pharmacies near you. Pharmacy pricing often varies from location to location. Sometimes the difference in pricing at pharmacies even within a few miles of each other is significant. So be sure to check the pricing at pharmacies near you on RxSaver, or call local pharmacies to see which pharmacy’s price is best.

Use a Manufacturer Coupon or Savings Program

If you’re prescribed a brand drug that your insurance has dropped, look online for manufacturer coupons. A search for the drug should lead you to the prescription drug website. The website may offer a coupon or savings program which can help reduce the cost of your medication.

How often does health insurance drop prescriptions?

Though insurance companies make the biggest adjustments to their formularies at the beginning of a year, they do modify them all year long. Prescriptions may be dropped anytime during the year. When prescriptions are dropped during the year, it is often because a generic alternative has become available.

Will I be notified when my prescription is dropped?

Unfortunately, you may not be notified if your prescription is dropped. You may only find out that it is no longer covered by your insurance when you go to the pharmacy to pick it up.

"If it was not for RxSaver, I would not be able to afford my medication."

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Always Check RxSaver for Prescription Savings

RxSaver offers significant savings on thousands of medications. So, be sure to check the website or app for savings on all medications. In some cases, the coupon price may even be less than your co-pay for medications covered by your insurance.

You do not need to provide an email, phone number, or other contact information to RxSaver to use the coupons. Simply pull up the coupon on your phone, and show your pharmacist, to get the coupon price for your prescription medication.

RxSaver Editors

RxSaver Editors

RxSaver Editors are wellness enthusiasts who help you learn how you can save the most on prescription medication costs and other health-related topics.

The information on this site is generalized and is not medical advice. It is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. Always seek the advice of your healthcare professional with any questions you may have regarding a medical condition. Never disregard seeking advice or delay in seeking treatment because of something you have read on our site. RxSaver makes no warranty as to the accuracy, reliability or completeness of this information.

If you are in crisis or you think you may have a medical emergency, call your doctor or 911 immediately.