Prescription Roadblock

I just spent an hour and a half on the phone with a commercial insurance company that was requiring repeat authorization on a medication that I have been taking for over 2 years. I was due to pick up the medication last week. When I called to see if it was ready, my pharmacy told me that the insurance company was requiring pre-authorization, which they had requested the day I called in the refill request. Mysteriously, the insurance company says they have “no record” of the pharmacy’s pre-auth request, nor a record of their own 2023 approval, a copy of which I have in my hands. When presented with this evidence, they said, “oh, that was only good for a year, we change what meds need pre-authorization from year to year.” It is unclear why I didn’t have trouble obtaining my meds in 2024. Same insurance company for the entire time period.

I am unable to reach anyone in the pre-authorization department of my physician’s office. They have not returned my calls. I’m sure they’re overwhelmed with these silly rules which not only impact hundreds, if not thousands, of their patients, but create busywork for providers and staff.

When I asked the 4th person at the insurance company (2 regular reps, 2 supervisors, of which 2 were offshore) why they were delaying my care, they said “we need to verify your medical records and that you still need the medication.” Well, if I didn’t need it, why would my doctor have prescribed it and why would I be paying the out-of-pocket costs associated with receiving it?

The US doesn’t have “the best” health care system in the world, it has one of the worst. And I still don’t have my meds.