Insurance requirements can delay access to needed prescriptions, but caregivers can advocate effectively. If your loved one is prescribed a new medication, start by checking to see if it is on the formulary for your loved one’s insurance plan or if prior authorization is required. This can save time and prevent surprises at the pharmacy.

If your loved one’s medication is denied:

• Request the denial letter to learn the reason.
• File an appeal with a letter of medical necessity from the provider.
• Explore patient assistance programs for copay or access support.

Taking these steps can often overturn denials and ensure access to the medication your loved one needs.

It’s also helpful to document all communications. Keep a log of calls, names, and reference numbers for appeals or prior authorizations. This information can be critical if you need to escalate the appeal.