Legal Question in Insurance Law in Florida

The latest insurance tactic. The paid prescription portion of my insurance no longer covers a full 30 day supply of certain medications, even if my doctor indicates dispense 1 months supply on the prescription. My current example is I take a medication that relieves migraine headaches. This medication is not a narcotic. The 30 day supply is a nine tablet pack pre-packaged from the manufacturer. The brand version of this medication is about $300.00 dollars for nine tablets. The medication works very well. At first, my insurance company indicated they would no longer pay for the brand medication. I would need to use a generic. I made the switch and found that the generic works just as well and cost $190.00 for a nine tablet pack. Last month when I went to refill, I only received 4 tablets. The tablets had been cut out from the normal nine tablet pack. The pharmacist indicated that my insurance would now only cover 4 tablets dispensed at a time, I can get 4 more tablets in 1 week. He said this was the first time he had ever seen this for this medication. Can I force the insurance company to dispense what the doctor ordered? I�m healthy and 48 years old and I have no problem getting around but I�m wondering about all of the retired and elderly and physically disabled people in our country that might be facing this same problem. Thank you for your response, Terry


Asked on 1/07/10, 4:45 am

1 Answer from Attorneys
Alan Wagner Wagner, McLaughlin & Whittemore P.A.

Don't you just love insurance companies? The Republicans tell us that they are great and we should trust them and that no competition is needed. Right! The answer top your question is, no, you an't force them to pay for something that does not fall within the coverage terms even if your doctor prescribes it.

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Answered on 1/12/10, 7:25 am


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