#88 - How to Get Your Meds Approved: Appealing Insurance Denial

Has your medication been denied? Now what?

Before patients can access medications—whether it’s inhalers or biologic therapies—they often have to jump through many hoops to get insurance approval. Navigating the world of health insurance approvals for medication can be overwhelming for both patients and providers. In this episode, we break down what to expect, what you can do, and how to advocate for yourself throughout the process.

Lacey Varnon from the National Association of Medication Access and Patient Advocacy (NAMAPA) joins Dr. G and Kortney to dive into the complex world of health insurance. Lacey shares insights into common reasons for medication denials, how to appeal them, and how patients and healthcare providers can work together for better outcomes.

What We Cover in Our Episode About Health Insurance Approvals for Medications:

• Health Insurance Basics: Understanding essential terms like payer and formulary.
• Navigating Insurance Approvals: Tips for a smoother process, understanding prior authorization, and common reasons for medication denials.
• Teamwork Between Patients and Providers: How patients and doctors can collaborate to improve chances of approval and streamline the documentation process.
• The Appeals Process: A step-by-step guide to appealing denials and ensuring access to necessary treatments.
• Support Programs & Resources: Insights into sample programs, bridge programs, and tools to help patients through the approval process.

More resources about health insurance denials and appeals: 

• Health Insurance Coverage in the United States
• Why was my prescription denied by insurance?
• Health Insurance for Asthma and Allergies
• Choosing the Right Health Insurance Plan
• Navigating Insurance Denials and Filing Appeals
• NAMAPA: National Association for Medication Access and Patient Advocacy
• Medication Access Network

This episode is made in collaboration with the National Association of Medication Access and Patient Advocacy (NAMAPA). We thank Amgen for sponsoring this episode.