Self-Funded Insurance Plans

[karen1027]

What rules do self-insured plans have to follow? Must they comply with laws in the state the subscriber resides?

Just received notice that an expensive medication will no longer be covered. Anything I can do? FDA issued warning last Fall that generic form is not as effective and is not equilivant to brand.

[GBurns]

There are different rules for different issues.

There are some state laws that apply in some states.

Did they say why? It could be that the medication was not effective.

There are very few medications that are the only medication that works for a particular ailment. Have you looked to see what else is used? There are very few medications that are the best for everyone. Quite often what works or one person does not work for another

Was the FDA warning about your particular medication? An FDA warning about one particular drug has nothing to do with any other drug.

[leevena]

More than likely there is nothing you can do about it. Whether the plan is self-funded or fully-insured, both can drop a drug from it's formulary.