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November 12, 2011 2:10 PM Subscribe
[Massachusetts filter] Anyone have any experience with Tufts medical plan and getting Wellbutrin XL (or any other brand-name psychiatric meds with generic equivalents) covered by them?
posted by anonymous to health & fitness (4 answers total) 1 user marked this as a favorite
Just started a new job. New job has Tufts health insurance. Looking at their paperwork, they seem to be really, really aggressive about not covering brand-name medications when there's a generic equivalent and the information about their prior-authorization process is murky at best. I reached out to them to ask more, but I just got the same party-line they've got all over their documentation about my doctor needing to prove it's a "Medical Necessity" without actually explaining what that entails. I asked my doctor's admin, and while she said she had the paperwork to show that I've tried a variety of other meds, she couldn't guarantee they'd cover it either (but didn't have a feeling for the likelihood, either).
I'm currently paying out the nose for HPHC through COBRA. HPHC's coverage of my meds just seemed to require a simple token confirmation from my doc...and I don't think I've ever been on a plan before that so emphasized their unwillingness to cover a lot of drugs or required the You-must-try-X-Y-and-Z-first hoops Tufts says they do. I'm terrified of switching to Tufts, losing my COBRA eligibility, and then being denied coverage and losing my meds - the Wellbutrin generics didn't work for me the last time I tried them (4 years ago) and I don't feel like playing brain chemical roulette again, especially not while I'm just starting a new job.
Now I'm looking for either anecdotes of anyone who's been approved (or rejected) for brand-name psychiatric meds with Tufts, or any other ideas for how I might confirm getting my meds so I can settle once and for all whether I can switch? Thanks!
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