What should I do if my medication is not covered?

If a medication is not covered by Wellpoint Next Rx, there are several steps that can be taken to explore options. First, it may be helpful to review the list of covered medications, often referred to as the formulary, which can usually be found on the Wellpoint Next Rx website. This list provides information on which medications are covered under the insurance plan. If the medication is still needed and is not listed, one option is to speak with a healthcare provider. Sometimes, doctors can provide alternatives that are covered. Additionally, there may be the possibility of a prior authorization, where the healthcare provider can submit a request to Wellpoint Next Rx to cover the medication based on medical necessity. Another option is to engage in a tiering appeal process. Members can typically appeal the decision by providing documentation of the medical need for the medication. It is essential to gather all necessary information and follow the specific appeals process outlined by Wellpoint Next Rx. Details regarding how to initiate an appeal or obtain further assistance can generally be found on their website under the relevant sections for members.