Fight Back Against Unfair Insurance
and PBM Practices
While you prefer to choose your pharmacy based on what best suits your needs, your health insurer or their pharmacy benefit manager (PBM) may want you to choose differently. Perhaps you have been contacted after filling a prescription and told you can reduce your costs by switching to mail order or some big box pharmacy. Maybe you’ve even been told that your preferred pharmacy is no longer innetwork.
Worse, have you ever gone to pick up a prescription at your pharmacy of choice only to find out your doctor never transmitted it to your pharmacy? When reached, the doctor’s office confirms it was sent to a different pharmacy, without your knowledge or consent, because your insurance company or PBM instructed them to send it there.
What you are experiencing is called steering and it is common with many patients who select a pharmacy based on their individual needs.
Here are some strategies and resources to help you fight back against your insurance company and PBM to demand access to your necessary prescriptions at the pharmacy of your choice.
Please note, whenever possible to communicate in writing so you have a record of the communication.
Worse, have you ever gone to pick up a prescription at your pharmacy of choice only to find out your doctor never transmitted it to your pharmacy? When reached, the doctor’s office confirms it was sent to a different pharmacy, without your knowledge or consent, because your insurance company or PBM instructed them to send it there.
What you are experiencing is called steering and it is common with many patients who select a pharmacy based on their individual needs.
Here are some strategies and resources to help you fight back against your insurance company and PBM to demand access to your necessary prescriptions at the pharmacy of your choice.
Please note, whenever possible to communicate in writing so you have a record of the communication.
- Contact your health plan or PBM- Click here for a sample letter or click here to build a customized letter. For a state by state breakdown of insurance plans, PBMs, and their contact information visit www.mypatientrights.org.
- Contact your employer, if you receive your health coverage through your employer - Click here for a sample letter to your employer or click here to build a customized letter.
- Contact the proper federal or state regulatory agency and file a complaint. If your health plan is a private plan, please contact your state insurance commissioner, if it is a Medicare plan, please contact the appropriate CMS regional office, and if it’s a Medicaid plan contact your state Medicaid Director to file a complaint about your plan. Click here to build a customized letter.
- Click here to send an email to your elected officials asking them to act to preserve your right to choose your pharmacy provider.