RefillWise is designed to save you money at the pharmacy. It fills holes in prescription coverage and gives you discounts if you don't have insurance.
But sometimes, just getting prescriptions authorized can take days or weeks or months, especially if you are one of the millions of people who use Medicaid for your primary or secondary insurance. Every prescription — whether for a drug, or a procedure, or equipment — requires an authorization. The backlog is sometimes more than 60 days just to receive your paperwork. Approval can take even longer. You can have your prescription denied because the paperwork wasn't correctly completed or it was missing a signature — or some other misunderstanding. Poor communication may delay — or prevent — getting needed medication.
This happened recently to Christine*. She was struggling with depression and needed medication to treat it. Her doctor prescribed her something, but she couldn't purchase her prescription immediately because she had to wait for authorization from Medicaid. Days went by while she struggled to manage her health. She called daily to check and the answer was always, "No, not yet."
In these types of situations, one of the most helpful resources is your State Senator or Representative. I contacted mine recently for an issue with Medicaid and I was amazed at how quickly our problem was solved.
Our Story
My oldest son is bright, funny, tenacious, and stubborn. He wants to be an engineer or a doctor when he grows up, or maybe a pirate. He's five, so he has time to decide. He loves to read, and his favorite subjects are math and science. But, if you met him, you wouldn't notice those things first. You would see the brace on his leg or the funny way he talks. You might notice that he has odd mannerisms and walks with a limp. That's because my son has a form of cerebral palsy called hemiplegia that was caused by a neonatal stroke.
He has difficulty using the right side of his body and also has a severe speech delay and several other learning and processing differences. He spends hours in therapy every week and uses devices like his orthosis and Alternative Communication Device that help him walk around and communicate. My son also needs regular treatments of Botox to help his muscles relax so he can walk.
Like many families with special needs children, we have two types of insurance for our child. We have primary insurance through an employer and we rely on Medicaid as our secondary insurance so that we can afford the therapies, devices, and treatments that help our son thrive. For every appointment or procedure our primary insurance is billed, just like normal — but anything they don't cover is billed to Medicaid. For instance, we use all of the 60 therapy sessions our primary insurance allows, but since that only covers about 10 weeks of the year, we use Medicaid to cover the rest. Just like with insurance, we have to prove that the therapy, device or treatment complies with Medicaid's strict rules.
Medicaid requires that our son be tested every six months to make sure he is meeting his therapy goals. They also take much longer to issue authorizations for his treatments and equipment than our private insurance does. It is a hassle, but it is worth it because the cost for all his medical needs is too much for us to manage without Medicaid.
Recently, though, I got a phone call saying that his authorization for therapies was denied. When I called Medicaid they said that someone at their company had flagged our son's authorization saying they needed a nurse to reevaluate if he really needed what the therapists prescribed. I spent hours on the phone talking with Medicaid and our therapy clinic trying to solve this and nobody seemed to know what was wrong or what to do next. Meanwhile, our son's therapy visits were cancelled because there was no insurance to cover them.
I was desperate, so I reached out to my State Senator Van Taylor hoping that I could at least give him some feedback about what was happening to real families using Medicaid as secondary insurance. To my surprise, someone from his office called me within an hour to ask if they could advocate for us with Medicaid. I signed the paperwork authorizing them to call Medicaid, and within a couple days someone from Medicaid called me back and the authorization was complete less than an hour later.
I'm so glad I reached out for help. Since then, I've learned a lot more about how State Senators and Representatives work. Their helpfulness was immediate and they showed genuine concern for us and our problem.
It is the job of our representatives to help advocate for us when we have problems with state services.
The Takeaway
If you have Medicaid coverage and can't get your prescription authorized, you are not without options.
Contact your State Senator or Representative to see if they can help you. You can find out who represents you here.
Call and check on the status of your authorization to see if you can help things go faster.
If you need a prescription and Medicaid has not yet authorized it, consider using RefillWise meanwhile to get a discount at the pharmacy.
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