On December 15, 2023 Aimed Alliance published a new resource titled Know Your Rights: Limited Formularies. Under the Patient Protection and Affordable Care Act (ACA) health plans offering essential health benefits are required to provide a process to plan enrollees to ensure they can receive access to non-formulary treatments that are deemed medically necessary. However, multiple different health plans are imposing barriers relating to this exception process, resulting in patients across conditions, diseases, and disorders experiencing difficulties accessing their medications. Therefore, Aimed Alliance is encouraging patients, caregivers, and providers to be clear when requesting coverage through the exception process that you are asking for a medical necessity exception. To help facilitate this conversation with the health plan, Aimed Alliance has developed this new resource available here.
Last Updated on January 26, 2024 by Aimed Alliance
