Navitus

My wife is a type 2 diabetic, she's been on various inject-able and oral medications for her entire adult life. She takes Ozempic now instead of Insulin. My insurance company contracted with Navitus health solutions. The contract is designed to reduce the plan's utilization which is a polite way of saying make getting needed medications more difficult to deter people from purchasing them and save the insurer $$$. Each year something happens. A computer error, a missing fax, something and Navitus (or the previous company) somehow forgets that my wife is a diabetic. We have to go through a cycle again to reprove her diagnosis. This involves a doctor visit just for that purpose and many hoops takes about 3 months and costs us ~$2000 out of pocket. Navitus does it's best to make this process difficult. They refuses to provide a form for the doctor to complete on which she could attest to my wife's condition or to accept faxed copies of her health records. Rather they require the doctor to re-issue prescriptions with a special diagnostic code electronically. This means making an appointment 30-90 days out to see the Dr solely to ask her to resubmit a prescription again. With the background out now let me get to the problem. We anticipating this again and called in December. We were told very clearly Don't worry this won't happen again we see the diagnostic code on the prescription and we also see an override code since this happened to you last year. I asked for this in writing and was told they would send a letter, it never arrived. My wife attempted to fill her prescription on Saturday and we had to pay ~$900 out of pocket. I've been battling the PBM for the last 3 days and was told yesterday in essence yeah we're stuck. call the Dr, make an appointment and in 60-90 days we'll cover it again. In the meantime don't stop taking the drug you need but also we aren't going to pay for it.. Do they think my wife grew a new pancreas over the new year's holiday?