New Year New insurance new PA process

Ratatosk

Administrator
Staff member
Just a reminder for those in the states to double check that your insurance isn't requiring you to go thru the prior authorization process. A few years ago I got caught off guard when I went to refill ds' Orkambi only to find despite my insurance not changing, we needed to go thru the pa process again. I spent every day on the phone for a few weeks before they finally reapproved coverage for a med he'd been on for awhile.

Fast forward to this fall and it took a few weeks for Trikafta to get pa. Knowing full well this year, that because we had to switch insurance to family coverage under me, I made sure in December that every pharmacy, vertex gps, clinic had my new information. Identical coverage as before, same group, but under me, not dh. Friday I got a text from the pharmacy reminding me to refill, only to find that they are waiting for pa documents from my clinic. Documents that have yet to be sent to said clinic. so we're down to a 2 week supply of Trikafta and pa usually takes 15-21 days.... So I'll be on the phone again for the next few weeks checking on the process, jumping thru hoops, sitting on hold....

So CHECK with your insurance, with Vertex gps, your pharmacy, your clinic and hopefully you won't be caught off guard like we were.
 

Ratatosk

Administrator
Staff member
So for the 2nd time in as many months, due to insurance changes, we've gotten through the prior approval process. This time he's approved for Trikafta for a year. Didn't miss any doses, down to a one week supply, but was approved a couple days ago and overnighted to us. Word of advice...when the clinic is sent info, ask them to mark it URGENT. Turn around is usually 72 hours vs. 15-21 days.
 
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