Insurance Denied Your Prior Authorization? Do This Next.

There is no letter more infuriating than the one that says your insurance company won't pay for the drug your doctor says you need. They call it a Prior Authorization (PA) denial. It feels like a faceless bureaucrat is making a medical decision for you.

Don't let them win. Their system is designed to make you give up so they can save money. Here is the advocate’s playbook for fighting back.

The "Step Therapy" Game

Usually, they deny you because they want you to try a "cheaper" drug first. This is called Step Therapy. But if you’ve already tried that drug, or if your doctor knows it will have a bad interaction with your other meds, you can bypass this. Ask your doctor to submit a "Letter of Medical Necessity."

The "Peer-to-Peer" Review

If the first appeal fails, demand a Peer-to-Peer review. This forces the insurance company’s doctor to get on the phone with your doctor. Often, when they have to justify their "No" to a fellow medical professional, they cave.

Bypassing the System Entirely

Sometimes, the fight isn't worth the stress. If your insurance is determined to be difficult, stop begging them for permission. Patient Assistance Programs (PAPs) are funded by the drug makers themselves and operate outside of your insurance.

We help patients skip the insurance battle and go straight to the source. We get the medication they denied you for $40 a month. You get the medicine, the insurance company gets ignored, and you get your peace back.

Stop fighting with insurance. Get your meds for $40/mo here.