So, your doctor prescribed you something, and you’re ready to pick it up—only to be told:
“Insurance denied it.”
Awesome. Love that for us. 🙄
Insurance companies love pulling this move because they’re banking on you saying, “Oh well, guess I won’t get my meds.”
👉 Nice try.
You can fight back—and win. Here’s how:
Why Do Medications Get Denied?
Let’s break it down:
🔄 They want you to try something cheaper first (aka step therapy). Insurance wants you to take their “preferred” drug before covering the one your doctor prescribed. Spoiler: Their “preferred” is usually the cheapest for them, not the best for you.
🛑 They claim it’s not medically necessary. They don’t know your body, but sure, go off.
🚫 It’s not on their formulary. That’s the fancy list of meds they’ll pay for. If your medication isn’t on there? Full price, baby.
What To Do If Your Medication Is Denied
Here’s the plan of attack:
1. Don’t Take “Denied” as Final.
A denial isn’t the end—it’s the beginning of negotiations. Think of it like haggling at a flea market, but the stakes are your health.
2. Call Your Insurance Company.
Ask these questions:
- Why was this denied? (Get specifics.)
- What alternatives are covered?
- Can I start a prior authorization or appeal?
Document names, dates, and details—treat it like a crime scene.
3. Get Your Doctor Involved.
Your doc can request a prior authorization (PA) or submit an appeal.
They may need to explain why you need this exact medication.
Pro tip: Ask your doc’s office for their medication appeal expert—there’s often one person who deals with this all day long.
4. Request a Medical Exception.
If you’ve tried other meds that didn’t work—or this one is the best option for you—ask for a medical exception.
This is basically your doctor telling insurance:
“Listen, this is the one. Approve it.”
5. If All Else Fails—Ask for the Cash Price.
Sometimes, the cash price (especially with discount programs like GoodRx) is cheaper than the insurance price withcoverage. Wild, right?
Extra Power Moves
💊 Pharmacy Hacks:
- Always ask if there’s a generic version.
- Check GoodRx or Cost Plus Drugs for lower cash prices.
- Some big-box stores offer $4 generics (hello, Walmart).
📄 Paper Trail = Power:
- Keep records of every call, every denial, every approval.
- If insurance says yes over the phone, get it in writing.
Don’t Let the System Wear You Down
Insurance wants you to give up—it saves them money. But you? You know better. You’re an Audacious Patient, and you’re not here to play.
💥 Want more scripts, tips, and step-by-step guidance on getting the care you need—without drowning in debt?
Check out my resources on Etsy:
📄 The Medical Debt Negotiation Guide – Learn how to slash your bills & fight for fair pricing.
💪 The Patient Power Guide – Master the art of self-advocacy with doctors & insurance companies.
🛒 Find them here: T.A.P. Etsy Shop
