Prescription Delays - Prior Authorization (PA) Requests
💊 PRESCRIPTION DELAYS 💊
Your pharmacy may tell you that your prescription is on hold or pending more info from your provider. The most common cause for delay is due to your insurance company requiring a Prior Authorization (PA). These delays vary by medication, insurance carrier and individual plans, making it impossible for us to anticipate in advance, however, the most common medications are for weight-loss, migraines, and ADHD.
❓ What Does This Mean?
Your insurance wants us to prove the medication is medically necessary. They usually won’t approve coverage until the following steps have been taken:
🔹 You’ve tried — and not had success with — a cheaper or generic alternative specified by your insurance plan (often based on employer-driven policies).
🔹 We submit detailed documentation justifying the need for this specific medication
💡 This is a cost-saving strategy from your insurance — not a medical decision. PA requirements often change frequently and may need to be redone with any dose or quantity change and annually.
📞 What You Can Do Right Now:
Call your insurance company and ask:
🔹 Why was the prescription denied or delayed?
🔹 What medication(s) must I try first?
• If you’ve already tried them, let them know — and tell us too!
🔹 Is the denial due to quantity or dosage limits?
• Ask what they will cover
📬 Please send this info to us via the Patient Portal or call and leave a detailed voicemail at ext. 114. Providing additional details can help us to better understand your plan and assist with the PA process.
⏳ How Long Will This Take?
Prior Authorizations can take up to 30 days for a final decision. Our team processes requests in the order they are received and works diligently to expedite them. You will be notified by your insurance carrier, who will inform your pharmacy of their decision. We are typically the last to be notified. Please direct any status inquiries to your insurance carrier or pharmacy, they can provide the most current updates. Calls to our office may not be returned timely due to the number of requests received daily.
💡 Don’t Want to Wait? Try These Options:
💰 Ask your pharmacy about cash price, GoodRx coupons or Manufacturer discounts
💬 If you’re okay with paying out of pocket, let us know, and we can proceed without PA delays.
We understand how frustrating this process can be — and we completely agree! Your provider has already chosen the medication they believe is best for you. We do not benefit in any way from the medications we recommend or prescribe. Unfortunately, insurance coverage decisions — including which medications are approved or denied — are both unknown to us and entirely out of our control. Each insurance carrier, plan, or employer may follow different guidelines, many of which create unnecessary barriers to care.