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this post was submitted on 31 Aug 2025
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Currently waiting to begin taking a medication my doctor prescribed because the pharmacy wouldn’t fill it without prior authorization from the insurance company, but to do that, they had to go back to the doctor to request the doctor fill out paperwork to send to the insurer.
During the appointment with the doctor, we already discussed that my insurer likely will not cover the medication, but looked up the retail price, which is not beyond my means or out of scale with the benefit I expect it to bring me. I’m okay paying out of pocket, but my pharmacy is locked into this process that has stretched out over a holiday weekend, so it’s likely I’ll get the medicine a week later than I otherwise would have.
This is more mental health related, and I’m okay physically, but if the blood tests and years of failed approaches from other methods are any indication, then this could show immediate and significant impact.
But I have to wait for the wheels of capitalism to grind on, so they can ensure maximum value extraction from a very expensive insurance policy.
Your pharmacy lied. There is no legal requirement to try to bill insurance first they presumably stand in many cases to bill them more especially if you cash paid only after coupons or patient assistance programs which are essentially coupons.
Thus they choose to follow this process and lie to you.
Oh, yeah. They didn’t even give me an option. Not even really a matter of them saying it was legal or anything. It was a quick awkward convo in which they were too rushed to really listen and I was too flustered to really make them.
I’m not all that annoyed at the pharmacy. They are trying to save me money. My comment is really more about how the insurer adds confusion and delays, because of their second guesses, insisting on verifications, etc.
Guess what. I visit my doctor, for free, (or dentist for $$$) they give me a prescription, I go to a pharmacy and give them the slip, they take some time to fill it, explain how to take it, and then I pay a small fee (80% covered by employer health plan at no direct cost to me) and walk away. Canadian healthcare system at work.
Sure, I have to wait sometimes for major surgery based on the triage approach (most serious cases seen first) but it is painlessly easy to get the care I need when I need it. This is how most of the developed world works. Your country is cheating you.