California residents rely on their health insurance to afford crucial medications. But what happens when your insurance company suddenly stops covering a prescription you need? California law offers some protection.
Generally, your insurance must provide notice before removing a medication from its formulary (list of covered drugs). This allows you and your doctor time to explore alternative treatments or appeal the decision. The specific timeframe for this notice can vary depending on your insurance plan, so review your policy documents carefully.
If your health necessitates continued use of the medication, you can often file an appeal or request a coverage exception. Your doctor will likely need to provide documentation supporting the medical necessity of the drug. Be prepared to advocate for your health and explore all available options. Familiarize yourself with your insurance plan's appeal process, and don't hesitate to seek assistance from consumer advocacy groups if needed. Knowing your rights is the first step towards maintaining access to the medications you depend on.
