How to Get Your Meds Approved: Appealing an Insurance Denial

Welcome to our new Allergy, Asthma & Immunology Innovations Podcast series on navigating health insurance. This episode explores how to work with your doctor to make the medication approval process easier. Find out what steps to take if your medication has been denied.

This episode is produced in partnership with The Itch Podcast. Lacey Varnon, ADN, PACS, BCPA, joins our co-hosts, Payel Gupta, MD, and Kortney Kwong Hing, to talk about how patients and doctors can work together to navigate health insurance. We explain key terms like payer, formulary, and prior authorization. Lacey also shares tips on how to handle the appeals process for getting medications approved.

Learn more about the podcast and hosts at ItchPodcast.com. The podcast can be downloaded on major platforms for listening anytime, anywhere:

This episode is made in collaboration the National Association of Medication Access and Patient Advocacy (NAMAPA). We thank Amgen for sponsoring this episode.

All opinions on the show represent the views of the podcasters and the guest. Sponsorship does not influence content or editorial decisions. Any mention of brands is for informational purposes and not an endorsement.

Understanding health insurance for medications

Lacey Varnon shares best practices for getting medications approved by insurance. She offers helpful advice for patients facing insurance denials and tips for working with providers to improve the chances of approval.

Dr. Gupta highlights the role of doctors in the approval process and the importance of a strong doctor-patient relationship.

Key takeaways about medication approvals

In this episode, we share practical advice for navigating the challenges of insurance approvals and medication access.

  • Health Insurance Basics: Learn important terms like “payer” and “formulary” to better understand your health insurance.
  • Prior Authorization and Medication Denials: Discover why medications may be denied and why the prior authorization process is needed.
  • Teamwork with Your Doctor: Understand how patients and doctors can work together to increase the chances of getting medications approved.
  • Appeals Process Explained: Find out what to do if your medication is denied and how to successfully appeal.
  • Support Programs & Resources: Explore programs that can help cover costs while waiting for insurance approval.

Timestamps for “How to Get Your Meds Approved” Podcast

  • 01:25 – Introduction to Lacey Varnon and NAMAPA
  • 03:24 – Understanding “payer” in health insurance
  • 04:14 – Tips for streamlining medication approvals from the first appointment
  • 05:01 – Explanation of “formulary”
  • 08:26 – Common reasons for medication denials
  • 10:00 – Explanation of “prior authorization”
  • 13:33 – Patient vs. doctor responsibilities in documentation
  • 16:24 – Impact of insurance on provider workloads
  • 18:41 – Working with your provider on authorization challenges
  • 19:58 – Recap of the doctor’s role in getting new medications approved
  • 21:06 – Steps in the appeals process
  • 24:46 – Overview of Sample Programs and Bridge Programs
  • 26:51 – Resources for navigating health insurance

Additional resources for health insurance