What if my drug is denied?

In the event that your drug has gone through the prior authorization review and has been denied then in most cases you will have the right to submit an appeal.  We will send you a letter that details the denial and the reason for the denial.  This letter will contain the information that you and your physician can submit for an appeal review.  Not all denials will be subject to the appeal process.  If a drug is excluded by your plan sponsor then Phoenix Benefits, as the administrator of your plan, are contractually obligated to deny that medication.  This is true even if the medication can be deemed as medically necessary.

Some brand medications may offer an assistance program for member who do not have drug coverage for a specific medication.  In the event that your drug is denied coverage you can visit www.needymeds.com and see if there is any assistance programs available to help you cover the cost of the medication.