Q: can a pharmacist withhold a refill medication due to CDS because it has not been pre-approved by health insurance.
Requested to pay out of pocket, long standing prescription
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A:
Yes, a pharmacist can withhold a refill if your insurance hasn’t pre-approved the medication. Insurance companies sometimes require prior authorization for certain prescriptions, even if you’ve been using them for a long time. This process ensures that the medication meets your insurance’s coverage criteria.
If the pre-approval isn’t granted, the pharmacist may ask you to pay out of pocket to avoid delays in getting your medication. It’s a good idea to reach out to your insurance provider to understand why the approval was denied and see if there are steps you can take to obtain it. Sometimes, providing additional information or having your doctor submit a request can help.
Additionally, discuss with your pharmacist any possible alternatives that might be covered by your insurance. They can offer suggestions for similar medications or generic options that might not require pre-approval. Staying proactive and communicating with both your pharmacist and insurance company can help ensure you continue your treatment without unnecessary interruptions.
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