What should I do if my prescription is denied?

If a prescription is denied by Express Scripts, there are several steps that one may consider taking to address the situation. First, it is important to review the denial notice, as it usually provides details regarding the reason for the denial. Common reasons can include lack of prior authorization, a medication being excluded from coverage, or not meeting the clinical criteria set by the health plan. Following this, one could consider contacting the prescribing healthcare provider to discuss the denial. The provider may be able to determine if an alternative medication could be prescribed that is covered or if additional information is needed to support the request for the denied medication. Additionally, it may be helpful to reach out to Express Scripts for clarification on the denial and to explore potential options for resolution. The company's website typically has contact information that can assist in this process. Furthermore, some individuals may have the option to appeal the denial, depending on their plan's specific procedures. Reviewing the benefits plan and any relevant documentation can also provide guidance on how to proceed. Overall, taking these actions can help in resolving the issue of a denied prescription.