What to Do When a Pharmacy Says Your Drug Needs Prior Authorization

Understanding the prior authorization process is key to getting your medications covered. If your pharmacy denies a claim, coordinate with your doctor to provide the necessary clinical documentation to your insurer. Zamrznuti tonovi/Shutterstock

Few things are more frustrating than standing at the pharmacy counter, ready to pick up a vital medication, only to be told it isn’t covered by your insurance. This often happens because the drug requires “prior authorization,” a process that can feel like an unnecessary roadblock to your health. While it may seem like a simple administrative hurdle, this requirement is a common tool used by insurance plans to ensure treatments are safe, medically necessary, and cost-effective.

Prior authorization has become one of the biggest sources of frustration for patients and healthcare providers. CoverMyMeds reports that 66% of patients experience delays of at least 24 hours when prior authorization is required, and those delays can sometimes lead patients to abandon treatment altogether.