Patients and Physicians Speak Out

I was denied a simple lidocaine cream because I could buy it over the counter. Now, I couldn’t buy the same strength over the counter, and nothing worked but this prescribed cream. What was once covered easily became a prior authorization medication. [It’s] super frustrating for such a simple prescription – I can’t even imagine having to wait for something like a cancer medication or insulin because of a prior authorization issue. Obviously, if your doctor is prescribing it, then they feel it is the best medication for you. The insurance company shouldn’t dictate what’s best for patients — they aren’t MDs.

I was approved for my medication and took it for 6 months. It lowered my blood pressure, A1C (hemoglobin) and hormones, and helped tremendously with my arthritis and joint pain. When it came time to renew my prior authorization, my insurance suddenly denied my doctor's request stating that they needed more records. These were provided and a peer-to-peer was done; however, they keep denying my doctor's appeals. 

Meanwhile, I’ve been without my medication for a month now. I can barely move from the pain from arthritis. I’m feeling a lot worse now and I cannot afford the out-of-pocket expense for my meds as I am the primary breadwinner, taking care of a 100% disabled veteran husband and our disabled daughter who has autism spectrum disorder.

I was diagnosed with Crohn's Disease. The medicine my doctor prescribed required prior authorization. While waiting for the appeal, my colon perforated. I received my approval letter the day I had emergency surgery to remove my colon.

The need for prior authorizations has caused me damage to my brain that I may never get back. I have multiple sclerosis, a lifelong illness, and my insurance company thinks they know what is best for me. WRONG! In 2015, my doctor wanted me on a medication called Gilenya, a [prior authorization] was sent to the insurance company and came back with a denial. Why? They wanted me to fail THREE medications of their choice before they would cover what my doctor said was best for me. I tried two of the three which led to terrible side effects and an allergy to one of them. Most of all it led to more lesions on my brain. In 2018, the need for a prior authorization for additional rounds of my current treatment led to 2 denials and a relapse during that time, again more damage that I may never recover from. I was told a board-certified neurologist would look at my appeal, I doubt they did. It wasn’t until I went to Facebook and posted on the insurance company’s page that I got momentum in the right direction. I was fed up with the process so on a post with the chief medical officer, I kindly asked if he could review my case. Less than 48 hours later my treatment was approved. It shouldn’t ever come to that. Insurance companies don’t know what’s best for a patient.

I am on Medicare with an assisted cost plan administered by [my health plan].  I have ADD, inattentive type. Every single psycho-stimulant drug for my treatment requires prior authorization. Every. Single. One. Quite a kicker that I need the drugs to be able to concentrate enough to get through the red tape to get the drug.