To Avoid Care Disruptions, Know When the Clock Runs Out on Your Prior Authorization

Summary: Jaclyn Mayo has multiple sclerosis (MS), a condition that affects her balance. Her doctor prescribed a weight-loss drug called Zepbound to help her walk better and reduce joint stress. It worked wonders—she could climb stairs, sleep better, and the numbness in her hands vanished. But after seven months, her pharmacy suddenly refused to refill the prescription.

Jaclyn discovered that her insurance company’s "prior authorization"—the permission slip to cover the drug—had expired without anyone telling her. While she fought through weeks of red tape to get a new approval, her painful symptoms returned. To avoid this, experts suggest calling your insurer to find out exactly when your approval expires, asking your doctor for an "expedited review" if you run out, and never being afraid to appeal a denial.

For more details, see kffhealthnews at kffhealthnews.org/news/article/health-care-helpline-prior-authorization-insurance-companies-plans-drugs-pbms-tips/ (opens in new tab)