Is it legal for an insurance company to mandate the pharmacy in which a person gets there medicine?

UPDATED: Oct 1, 2022

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Is it legal for an insurance company to mandate the pharmacy in which a person gets there medicine?

Mandatory use of express scripts by

Asked on January 25, 2018 under Insurance Law, Kentucky


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 4 years ago | Contributor

If the terms of the policy give them this right, then it is legal. An insurance policy is a contract: like any other contract, the parties to it--including, in this case, the insurer--have whatever rights and power, and only those rights and power, that the contract (or policy) gives them. So if you have a policy which states the insurer can do this, they can: your recourse would be, when this policy expires, to purchase a different policy without this, and/or go to a different insurer.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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