02/18/2026
We want to make you aware of something we're seeing more of this year: handling prior authorizations for medications is hard to understand and becoming harder to navigate. We're here to help you understand.
What is a Prior Authorization (PA)?
Your provider sends your prescription to your pharmacy. Your insurance tells the pharmacy a PA is needed. The pharmacy sends the PA documents to your provider's office. Your provider's office sends clinical data supporting your medication need and gets approval/denial. Traditionally, if approved you pick up your medication and the process is complete.
What is a Deductible?
A deductible is the amount YOU must pay out of pocket before your insurance helps pay for medications. Example: If your deductible is $1,500 and a medication costs $200, you pay the full $200. Once you've paid $1,500 total for the year, your insurance kicks in and medications become more affordable. Even with an approved PA, you may still need to meet your deductible first.
Here's what's we are noticing this year:
Some insurances, even after PA approval, continue showing "a PA has to be completed" to the pharmacy. This is the communication gap. Many are also moving to variable copay programs requiring YOU to call and apply. To us, the process looks complete—but the insurance directs you to fill the medication at a unfamiliar pharmacy or get a one time voucher to fill it at your local pharmacy.
Here's the reality:
Insurance is requiring patients to do more work. We know it's frustrating. But your LOCAL HOMETOWN pharmacies and provider offices are doing everything we can. We work incredibly hard on PAs. Sometimes gaps in insurance communication exist that we simply can't fill.
What you can do:
Call your insurance company directly. Ask about PA requirements, variable copay programs, and understand your deductible status. This helps you access your medication quicker.
FAQ: "My insurance has always paid for it why isn't it paying now"? Formularies change, requirements change, you may have previously been under a manufacturer coupon that has expired. Ultimately insurance decides.
We're here for you and doing everything we can.
