#prior authorization for medication

[battywitch]

I think anyone denied medication should be allowed to bite whoever made the call

[qazastra]

this country is a joke for countless reasons but what do you mean i just won’t be getting my medication (that ive already been taking for months) until my insurance decides they want to press a button in a few weeks. Cool. set tge world on fire <3

[yeah-thats-probably-it]

i hate this vyvanse shortage i’m so sick of it wishing every pharmaceutical executive a personal go to hell. also wishing every insurance company executive a personal go to hell. and to whoever invented the us healthcare system sending you an extra special fahr zur hölle if you would be so kind bitte

[chuellas]

Walmart Pharmacy in my area, you better count your days :)

[stimmingandstruggling]

ooooooh insurance company you want to approve my testosterone prescription soooo bad

[xerserise]

Medicare Part D — a tragic saga

I'm on one single prescription medication. It's a controlled substance.

I'm on federal insurance for medication. Since I'm in the United States, that means a for-profit third party gets to manage that insurance policy. Though it must meet or exceed specific guidelines from the government.

At the end of 2023, I got a letter from the government saying I'd need to start paying a small monthly premium to the third party, or I could switch to a different third party provider on the back of the letter. I didn't switch, because of ADHD and demand avoidance, it was a small enough amount of money, and I didn't want to risk issues with my medication being denied or delayed with a new insurance company. But I was worried about the future.

Sure enough, at the end of 2024, there was a letter from the government saying that my third party insurance company was upping the premiums to an amount I absolutely wasn't going to pay if I didn't have to. But that I could switch to one of the providers on the back of the letter and have no monthly premiums, while keeping the same 'Medicare Part D' that I already have.

I used the government's website, to make sure my medication was on the list of meds for the new provider. Yes. I made sure my pharmacy was accepted by the new provider. Yes. I used the government's website to switch to the new insurer. I got the new insurance card. I showed it to my pharmacy and updated the records. I went to my pain doctor and renewed my prescription for the next six months. I went to the pharmacy and picked up the medication. I went to the mailbox and opened a letter from my new insurance company.

They were kind enough to fill the prescription this time, as a courtesy. But they want a prior authorization or special exception completed before I request a refill. And told me to call my prescriber.

I called my prescriber's office. The automated reception message said that if I was calling about prior authorization, to contact the pharmacy and have them contact the doctor directly (who would then fill out and send documents to the pharmacy, who would then send the documents to the insurance company).

I went to my pharmacy in person (calling is not a good way to get things done there). Because my medication is a controlled substance (which is part of why it needs prior authorization), refills can't be requested until two days before they're due to run out. And prior authorizations can't be requested unless it's part of a refill request.

So, in order to keep from running out of an important medication, I'm supposed to contact my prescriber, who wants me to contact the pharmacy, who needs me to wait until I'm supposed to be almost out of medication before they can start the process of asking my doctor to write a note and send it to the pharmacy so they can send it to my insurance company explaining why I need the medication my doctor prescribed, so that my insurance can decide whether they'll pay for it (despite me having been on this same medication and this same government plan, through a different third party, for years).

[roomtemperaturesuperconductor]

YOU’RE GIRL IS BACK ON ADHD MEDS LETS GO METH LETS GO METH WOOOO

[medicalxbilling]

[fraye-complex]

Doctor said I could have Androgel

Insurance said lemme think about it

Fuckers

[ophilosoraptoro]

Whistleblower Exposes Health Insurers' Most Evil Scheme

[princesslink]

after not having one of my meds for a month I finally got it filled today 🎉

[little-eye-guy]

ohhhh this is about to be a real pain

[lastamericanhero]

my freaking adderall. now please

[ivebeenmade]

I already knew that 'prior authorisation' policies had gotten out of hand, but it actually hit me personally today.

The doctor bumped up my Lyrica, a non-narcotic pain management medication, and when I called the pharmacy to ask if it would be ready to get tomorrow, they explained that it had hit a PA. The reason?

My doctor wants me to be taking 100mg in the morning, 50 in the afternoon, and 100 at bedtime. She prescribed this in 50mg capsules. The insurance "does not allow" for more than 3 pills of this med per patient per day.

Does Not Allow. As if an insurer understands the needs of a patient, or should ever have a say over a medical professional.

This means the doc has to send 2 different prescriptions in. One total 50mg capsule for the midday dose, two total capsules per day for the morning and night.

So I have to organise and remember two different pills for the same med every day; taking one bottle everywhere with me so I can take it around lunch, keeping the other home for my pill organiser.

What a giant pain in the ass. What a totally weird restriction.

What's even worse is that I literally just took my last full dose today, and this med can cause pretty nasty withdrawal symptoms.

I have 2 more 50mg doses I am going to space out for the next 2 days- *just in case* asking them to rewrite scripts in a way my insurance approves of doesn't get done in the hours the primary care office and the pharmacy are both open tomorrow.

[swordandstars]

Signal booooost to all my New Jersey people!

And to any Americans on the fence about voting next Tuesday, legislation like THIS is why voting in every state and local election is so important!

[wickedhawtwexler]

crying during a phone call with your pharmacy because every month you have a new crisis while getting your medication #justadhdthings #lovelife