Patients and Physicians Speak Out

My wife has metastatic lung cancer. She had many tests and is on the drug Tagrisso (Osimertinib). She has had three targeted radiation treatments for small brain tumors. Now, the doctors would like to perform targeted radiation on the central mass in her lung. There have been preauthorization requirements every step of the way, causing considerable cumulative delay. Now, she is waiting for preauthorization for the targeted radiation treatment for the mass in her lung. It has been 12 days, and the treatment has been delayed twice. The insurance company just says, "they have 15 days." So, they are basically delaying treatment, because they can.

Every year, I have to ask my physician to fill out a prior authorization for a maintenance medication that I have been on for 20 years. Frequently, I have to pay out of pocket as my doctor and I try to figure out what they want/need to authorize the medicine as the company will always deny first round. What is the point of denying coverage for a maintenance medication? What is the point of re-submitting the same paperwork year after year? It's costing all of us money, including the insurance company – who in turn charges us more.

I waited weeks to get preauthorization for my cancer pills (Abiraterone Acetate), which is a part of my doctor's treatment for prostate cancer that has spread. Not only has it delayed my treatment, but it caused me great stress and mental anguish, while all I should be worried about is fighting this awful illness. Something needs to be done about this!!!

I am a caregiver for my husband, and we are both 78 and 79. We are having a problem getting my husband's cancer medication, because of prior authorization. This has to stop!!! The doctor is prescribing this medication as part of his treatment, because he needs it to live!!! It doesn't matter how old you are, LIFE IS PRECIOUS!!! This prior authorization and decision is being made by people who are not doctors, and they are overriding what the doctor knows is the medication and treatment that you need to survive. [Prior authorization’s] causing great harm and unneeded stress to patients and loved ones when they're already fighting for their life against cancer that, without their prescribed medication, could and will kill them. Something needs to be done about this. IT IS SO WRONG!!!

HealthNet, my insurance since 2010 who has never denied anything, suddenly stopped covering Rinvoq, the only Rheumatoid Arthritis medication that has work for me since I was diagnosed in 1999. I had already been taking it for several months and in January 2025, suddenly the prior authorization information they requested was not sent (yes, it was, 3 TIMES). I have been without my meds for 3 months! What happened between December 2024 and January 2025? My Doctor of 20 years is just as frustrated with the runaround. Next step is reaching out to Insurance Commissioner and seeking legal representation.

We found out our son has asthma after two frightening trips to the emergency room (ER}, followed by days in the hospital when he was four years old. The doctors prescribed Flovent as a maintenance treatment to help keep his airway clear and prevent return trips to the ER when he would get an illness. The first time I tried to pick up this medication I heard of “prior authorization.” I thought, “What does this mean?” The doctor prescribed it, so why does an insurance company get to decide whether it’s required? Luckily, the doctor was able to get it approved quickly. The next time I tried to pick it up, it was the same - why would they need to approve it again for the very same medication? This time, I ended up paying out of pocket because I needed it that day to continue treatment. Over the past two years, he’s been using this [medication] and I’ve been held up at least half a dozen times for prior authorization for the same medicine for the same ailment - it has not changed!! Why does it have to continually get approved? With the new plan year, we may have to move to a different medicine, which is incredibly unfortunate for a young child to have to switch from something that is working to an unknown.