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.
Kristen M., California