My patient met the insurance company's prior authorization criteria, which was reasonable. Yet, the authorization was rejected, so I appealed. It was rejected again, even though I pointed out to the agent on the other end of the line that the patient met the criteria. I was about to give up, but decided to call the medical director of the insurance company instead, who granted authorization. I wonder how many people would have given up rather than continue the fight and how much money the insurance company thought it was saving by denying legitimate drug use.