This is in response to the complaint received by *** A***, a GlobalHealth memberMr*** complainsthat GlobalHealth has deniedhis prescription drugsand does not have the dependent
coverage set up appropriately on his account.According to our records, Mr*** was
requesting a
90-day supply of two prescriptions at a retail pharmacyUnder Mr***'s
benefit plan, only maintenance medications are available for a 90-day supply at a retail pharmacy; however, Mr*** could receive a 90-day supply through his plan' s mail-order pharmacyAlthough Mr*** uses
these medications on a daily basis, these specific medications are not considered maintenance due to other indications (e.gblack box warning)Nevertheless, Mr*** has received the
needed medications.Mr***
also complains about a delay in receiving needed medicationsThis
specific medication requires prior authorizaiton by GlobalHealth
before Mr*** can receive the medicationThis medication was initially approved on 9/23/for monthsTherefore, on 9/22/2016the authorization expiredA new
prior authorization request was received on 10/26/and GlobalHealth
approved the request the same dayAlthough there may have been a delay in receiving the medication, it was due to the
priorauthorization requirements attached to that medicationGlobalHealtb requires a new authorization after an authorization expires in order to re-reviewthe necessity for that medication.Furthermore, Mr***complains that GlobalHealthdoes not have the dependent coverage correctly attached to the subscriber' s coverage recordGlobalHealth's eligibility and enrollment department reviewed Mr***'s
dependent issue, and all dependents are showing as active in the
coverage record. Thus, this issue is resolved
This is in response to the complaint received by *** A***, a GlobalHealth memberMr*** complainsthat GlobalHealth has deniedhis prescription drugsand does not have the dependent
coverage set up appropriately on his account.According to our records, Mr*** was
requesting a
90-day supply of two prescriptions at a retail pharmacyUnder Mr***'s
benefit plan, only maintenance medications are available for a 90-day supply at a retail pharmacy; however, Mr*** could receive a 90-day supply through his plan' s mail-order pharmacyAlthough Mr*** uses
these medications on a daily basis, these specific medications are not considered maintenance due to other indications (e.gblack box warning)Nevertheless, Mr*** has received the
needed medications.Mr***
also complains about a delay in receiving needed medicationsThis
specific medication requires prior authorizaiton by GlobalHealth
before Mr*** can receive the medicationThis medication was initially approved on 9/23/for monthsTherefore, on 9/22/2016the authorization expiredA new
prior authorization request was received on 10/26/and GlobalHealth
approved the request the same dayAlthough there may have been a delay in receiving the medication, it was due to the
priorauthorization requirements attached to that medicationGlobalHealtb requires a new authorization after an authorization expires in order to re-reviewthe necessity for that medication.Furthermore, Mr***complains that GlobalHealthdoes not have the dependent coverage correctly attached to the subscriber' s coverage recordGlobalHealth's eligibility and enrollment department reviewed Mr***'s
dependent issue, and all dependents are showing as active in the
coverage record. Thus, this issue is resolved