Can't get a prescription renewed? Here's how to cope with prior authorizations

"It was really helping me. I could go up and down stairs and not feel like I was going to fall. After being on Zepbound for seven months, she fell into an insurance pitfall: prior authorization. In August, her pharmacy wouldn't refill her prescription, and it wasn't clear why. She called her pharmacist, then her doctor's office, the pharmacist again, and finally her insurance company."

"Why do I need a prior authorization for something that I am already prior authorized to take? If my doctor says that they want me on a medication, why does my insurance have another say in that? Insurers require prior authorizations for certain treatments or tests, especially costly ones. When they do, your doctor has to make the pre-authorization request to your insurance company, explaining why you need the treatment."

Jaclyn Mayo, a multiple sclerosis patient, was prescribed Zepbound, a GLP-1 obesity medication, to improve her balance and mobility. The medication proved effective, helping her climb stairs safely and alleviating additional MS symptoms including sleep disturbances and hand numbness. After seven months of successful treatment, her pharmacy refused to refill her prescription because her insurance prior authorization had expired. Despite her doctor's ongoing recommendation and demonstrated medical benefit, Mayo had to navigate multiple calls to her pharmacist, doctor, and insurance company to understand why her approved medication was suddenly unavailable. Prior authorizations are insurance requirements for certain treatments, particularly expensive ones, but these approvals have expiration dates that can interrupt patient care.

Read at www.npr.org