Sometimes an insurance company will deny coverage for a prescription. This is usually because of a process called “prior authorization.” But there are some simple steps you can take to help you get the prescription that you and your doctor have decided is the best treatment for you.
What is prior authorization (PA)?
Some health insurance plans need a PA before your medication can be approved. This means that your doctor needs to fill out a form that proves that you are an appropriate patient for KERENDIA.
Why was my coverage denied?
Sometimes the PA is not filled out or processed correctly, so the insurance company denies the coverage. Or, the insurance company may decide that you do not meet their criteria for that specific drug. Either way, there are things you can do.
What can I do if my coverage is denied?
Call your doctor’s office and ask to speak with the Benefits Manager. The Benefits Manager will make sure that the claim was submitted correctly or work with your doctor to appeal the decision on your behalf. Your doctor’s office can download a sample appeal letter on KerendiaHCP.com/accessresources.