Reader Mail: Warning -- Harvard Pilgrim Health Care is Denying Coverage of Thyroid Medications...Unless They're Generic!

A reader writes: First of all, I want to thank you for all of the great work that you do! Your sites have taught me how to stand up for myself when it comes to the medical powers that be. At any rate, I wanted to share this incident with you, as I was tod this is happening a lot lately. My insurance is Harvard Pilgrim and generally speaking, I've had no complaints. That was up until an hour ago! I went to my local pharmacy to pick up my Levoxyl, when I am informed that --surprise!-- my insurance will only pay for a generic version and not what was written. Harvard Pilgrim never mentioned this policy change to anyone, apparently; they just snuck it in when no one was looking. I offered to pay out-of-pocket to get my rx as written. It was filled and through some miracle, the pharmacist managed to get Harvard Pilgrim to cover it. She told me that the same thing has been happening to many patients, which is why she was telling people about the policy change (apparently, other insurances have decided to follow suit). I went home and fired off an email to Harvard Pilgrim's Member Services Department:

* * * I have a complaint I would like addressed. I am a hypothyroid patient and have been taking a certain medication for this problem (Levoxyl) for years. Today, when I went to the pharmacy to pick this prescription up, I was informed that Harvard Pilgrim will only pay for the generic version of this medication. While I was aware that generics for this drug were recently made available, my doctor did not write out a prescription for a generic and I was surprised to find that my insurance was denying coverage. Eventually, the pharmacist was able to fill my Levoxyl as written and instructed me to make sure that the phrase "no substitutions" is included on the printed prescription.

While in most cases, the generic is bioequivalent to its "name" brand competitor, the same cannot be said for thyroid hormone replacement therapies, and this is a very well documented fact. Delmar's Nurse's Drug Reference states the following warning : "Due to differences from one brand to another, brand interchange is not recommended without consulting with the provider." Switching patients' drugs wreaks havoc upon their already struggling system. Please reconsider your stance on thyroid replacement therapies.

Sincerely,

Amanda N. * * * I am letting my doctor know before she finds out the hard way, too! I was able to get the medication that my doctor intended to give me; how many people may have not even checked their prescriptions for substitutions? Keep an eye on your medicine bottles, everyone! ~Amanda Nichols