The insurance company denied coverage for a prescription because I had not yet tried two other medicines that are irrelevant to the issue we’re trying to solve.
I was prescribed medication that prevents a skin condition from occurring. The insurance company denied my PA request, stating that I did not have a history of failure from two other drugs and that I needed to show that those drugs weren't working before they would prescribe me the originally requested drug. The issue is that the originally prescribed drug prevents the issue from flaring up/occurring so that I don't have the painful and scarring side effects that come with the flare-up. The recommended drugs they want me to try only treat the condition after a flare-up has occurred and do NOT prevent the flare-ups from occurring, so I still have to deal with the painful welts and scarring that occurs from the flare-up each time. I would like to appeal their decision, but I'm wondering what the best method/wording/process would be before I knowingly waste money on appointments and medications that I know will not work just to get the original prescription finally approved.
submitted by /u/PsychologicalKitten
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