However, we do recognize that there are individual patient exceptions. For this reason, the medication you need is covered, but at the non-preferred copayment. There are no exceptions made to the copayments specified. Some benefit designs do not cover non-preferred brand name medications under the mail order benefit. Changes to the PML will be made annually.
Annual notification is sent to agents, group administrators, physicians, and pharmacists.
Sometimes new clinical studies demonstrate that two or more medications work the same way. When there are choices, medications considered to be the best value are available for the preferred copayment. My medication used to be on the PML, now it is not. Yes, if you continue taking the same medication. Medications that were deleted from the PML are either now available generically or have one or more less costly alternatives available.