September 8, 2020 Ashley Struble

Getting a Patient Out of Insurance Limbo

From a Specialty Pharmacy Liaison: Recently we had a patient who was prescribed a Limited Distribution Drug (LDD) by one of our Infectious Disease providers. Unfortunately, the medication was not available through the patient's local pharmacy and it was a medication that also required prior authorization from his health insurance company. Instead of figuring out a solution, the insurance company left the prescription on hold in a patient profile system, stranding the patient in limbo.

Making the situation worse, after a week of inactivity the provider let the patient know that no pharmacy could supply him with the medication due to the insurance restriction. After the provider updated the patient, he reached out to us at the hospital specialty pharmacy to help his patient. Within a few hours, our pharmacy team was able to find a new specialty pharmacy, approved by his insurance company, that could get the patient his medication. In addition to finding a new pharmacy to fulfill the prescription, we were also able to get the prior authorization from his insurance company within 72 hours.

Even though the medication wasn't filled through our hospital specialty pharmacy, it was still so rewarding to collaborate with the provider and get the patient his medication. When I spoke to the patient confirming his medication was delivered, he was very thankful for all the work we did to get him back on the medication therapy he desperately needed.