PATIENT QUESTION:
My medication/prescription provider has denied my doctors request for a new medication. What ways can I advocate for myself to see if I can get this medication approved or inquire as to why it was denied.
NURSE NAVIGATOR:
A medication denial can be frustrating, but a denial does not always mean you’re out of options. Time to do some investigating!
Start with asking your insurance or prescription provider why the medication was denied and request a copy of the denial letter.
Once you know the reason, ask your Doctors office what options are available. They may be able to provide additional documentation, submit a prior authorization, request a reconsideration, or file an appeal.
Example questions to ask your insurance/prescription provider:
- What specifically is required for this medication to be approved?
- Is there another medication I’m required to try first?
- What information or documentation is missing?
- What is the deadline to appeal?
- What are my next steps if the appeal is denied?
As a last resort, you can explore medication savings programs. Depending on the medication, there may be manufacturer savings programs, patient assistance programs, or other resources that can help lower your out-of-pocket cost.
As always, please reach out for support. We are here to walk alongside you in your journey! 💜
This information is for educational and resource purposes and is not medical advice.
If you have a question you want featured in our “Ask the Navigator” column, please send an email to hanna@colorofgi.org!
