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nicklo62

Prior Authorization For Accutane?

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So I finally decided to go on accutane, I got the blood work, and the script. When I went to go pick it up, my scum bag insurance company said they won't pay for it, because I am over 25. I've been going to the derm for many years now for cystic bacne, and nothing has worked. My pharmacy and doctor did something called a "prior authorization", and they denied it once again, then I put in an appeal, and they denied it. I have blue cross & blue shield along with express scripts. Wtf? Has anyone dealt with this before? I searched for a topic and can't find anything on it. I need advice on what to do, I'm so pissed off. I pay $400/week for medical insurance, almost as much as I make, and they don't cover anything I need!

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That is strange. I have the same insurance with same pharm coverage. Perhaps a different plan? Is it PPO, HMO..?

I did need a prior authorization but it was take care of within 24 hours. Is your insurance private or through an employer?

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It is through an employer, I'm in a good union, but I don't know if it's pop or HMO, I'd have to find out. It took 2 days to get my prior authorization denied, now it's on a 2nd appeal. They said they don't give accutane to people over 25, because they don't get acne. I think prior authorization is just an obstacle they throw up to save them billions of dollars, they are crooks. I'm so pissed off that nothing is working, and my derm wants me on it, but these idiots who don't even know me are saying I don't need it. I don't know why I have to pay $10/hr into this system, and is can't use it when I need it.

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I have Anthem BC BS but mine is through my state...no issues at all having insurance cover and my derm gives me a coupon to use so I only pay $10 a month for the pills.

And did the insurance really say - people over 25 don't get acne? That is ridiculous!

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Yup, they said that. They are just trying to save the $3,000 it will cost. It get on my nerves, because I contribute a lot of money to healthcare, and I never use it. The first time I need something, I get denied. My derm and the pharmacy says they will appeal again, but I lost all hope. I guess I'll have to wait until I have $3,000 to throw away.

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