11/20/2025
đĄ Why canât they just tell us if the med is covered or not?! It really is a simple question.
Doing a âPAâ is not a simple task. First the med needs to be sent to the pharmacy to trigger the PA. Then it requires documentation of the diagnosis, an office visit note and answering a litany of questions. They generally take up to 20 minutes to complete and even more if the patient has not been seen in a while. Thus causing more delays for the patient.
As a patient, here is what you can do to be more proactive to ensure coverage.
When asking your insurance company for coverage, you should ask the following information:
1. Is this medication on formulary?
2. What are the criteria (diagnosis codes needed)
3. How much is the copay if covered?
Please note, they will do everything they can to get you off the phone, so be persistent to ensure coverage is really what they say.
