Patients and Physicians Speak Out

I have treatment-resistant depression. My psychiatrist prescribed a medication that is non-standard after the standard medications failed. My insurance objected, but then agreed to let me try it. However, because the insurance required a new prior authorization every month (causing a 2-week delay in filling the prescription), I was unable to take the medication consistently due to running out of it every month, so I never received enough of the medication for it to have a chance of working. It was a lot of trouble, and I gave up, due to my continuing depression.

My dad was not able to get prior authorization for a PET scan to determine if his cancer had spread. Months later, a tumor was found via CT [scan] in his pancreas, and he ended up passing away from it. If he received that PET scan when his oncologist ordered it, it may have shown the pancreatic tumor earlier. Early intervention could have prevented a delay in care that may have led to his ultimate demise.

My daughter finally found a new drug that cleared up her psoriasis. The dermatologist gave her a few samples and within a week the psoriasis was completely cleared up. She has had psoriasis for about 30 years. She has tried many other treatments, and none have made it completely clear up. Her medical insurance denied her claim for a prescription because she hasn’t tried a few other treatments they want her to try. If your doctor prescribes something and it works so well, why are they questioning the doctor? My answer is because it is a new drug that probably costs more than the other treatments they want her to try.

My daughter who is disabled and on Social Security Disability has been on methylphenidate ER for 20 years. She is on Medicare and has a Humana Part D prescription plan. Her medication must be prior authorized each year.