Documentation:
Problem Summary:
I had transferred a medication from one pharmacy to a mail order pharmacy. I then encountered a problem whereby the rx was denied by health insurance per pharmacy customer support. My insurance had recently changed from 2020 PPO to 2021 CDHP. I then called my insurance company who explained the medication required prior authorization. The call ended, and I then surfed my health insurance provider website. I observed the document ‘2021 Prescription Drug Guide’. There were multiple listings within the document for Tadalafil, qty5 total listings. One row required prior authorization, tadalafil (pah) (Adcirca). Qty4 rows did not, tadalafil erectile dysfunction (my issue).
I proffered the Prescription Drug Guide documentation to health insurance online customer support that allows for attachments. They replied “Unfortunately, the prescription drug list does not list all the requirements for each drug.” The list I proffered, from their website, does in fact list the drug as not requiring Prior Authorization. I came to this sub, I read threads pertaining to Prior Authorization. The reddit threads mentioned the state department of insurance. I opened a claim with respect to my issue. I have a claim number, etc.
I remained in contact with the insurance company. Today they proffered the document they’re using when making the decision they’re enforcing, Medical and Drug Policies, Oral Pulmonary Arterial Hypertension Agents Prior Authorization. It lists tadalafil as requiring Prior Authorization.
I searched looking for a policy for the drug for my use in the alphabetical list, but i’m not a doctor and there isn’t one for the my issue, Alphabetical Policy List
My question to you all today is which document is the one that should be utilized? Why are there differing points of data available with respect to this medication, tadalafil one specifically saying that Prior Authorization is not required, another saying that it is required? Does my claim to department of insurance stand a chance?
Thank you!
submitted by /u/howcanibhelpful
[link] [comments]
Documentation: Prescription Drug Guide Medical and Drug Policies Problem Summary: I had transferred a medication from one pharmacy to a mail order pharmacy. I then encountered a problem whereby the rx was denied by health insurance per pharmacy customer support. My insurance had recently changed from 2020 PPO to 2021 CDHP. I then called my insurance company who explained the medication required prior authorization. The call ended, and I then surfed my health insurance provider website. I observed the document ‘2021 Prescription Drug Guide’. There were multiple listings within the document for Tadalafil, qty5 total listings. One row required prior authorization, tadalafil (pah) (Adcirca). Qty4 rows did not, tadalafil erectile dysfunction (my issue). I proffered the Prescription Drug Guide documentation to health insurance online customer support that allows for attachments. They replied “Unfortunately, the prescription drug list does not list all the requirements for each drug.” The list I proffered, from their website, does in fact list the drug as not requiring Prior Authorization. I came to this sub, I read threads pertaining to Prior Authorization. The reddit threads mentioned the state department of insurance. I opened a claim with respect to my issue. I have a claim number, etc. I remained in contact with the insurance company. Today they proffered the document they’re using when making the decision they’re enforcing, Medical and Drug Policies, Oral Pulmonary Arterial Hypertension Agents Prior Authorization. It lists tadalafil as requiring Prior Authorization. I searched looking for a policy for the drug for my use in the alphabetical list, but i’m not a doctor and there isn’t one for the my issue, Alphabetical Policy List My question to you all today is which document is the one that should be utilized? Why are there differing points of data available with respect to this medication, tadalafil one specifically saying that Prior Authorization is not required, another saying that it is required? Does my claim to department of insurance stand a chance? Thank you!
submitted by /u/howcanibhelpful [link] [comments]Read Morer/HealthInsurance