Why Isn’t My Medication Covered? Understanding Pri...
Why Isn’t My Medication Covered? Understanding Prior Authorizations
Demetra Koutmanis
Jul 31, 2026
4 minutes read
Sometimes your insurance company may not immediately cover a prescribed medication in these situations, in certain cases insurance companies may require a prior authorization before approving coverage. While this can delay access to a medication, there are several steps you can take to help complete the process and obtain coverage.
What is a prior authorization?
A prior authorization is a requirement by your insurance company that asks your provider to submit documentation before your medication can be covered. In other words, the purpose of this process is to confirm that your prescribed medication is medically necessary and appropriate for your condition.3
What to do when you receive a prior authorization requirement
Majority of the time it could be a minor issue as to why it is on hold before it is covered. To quicken up this process to get your prescription covered as soon as possible, the steps you can take is to:
Contact your provider’s office to make sure they are aware that your prescription has a prior authorization request
Confirm any additional medical records or documentation has been submitted to the insurance company
Follow up with your insurance company regarding any status of the request
Ask your local pharmacy whether if there are alternatives options available while waiting for approval
Clear communication between you, your provider, pharmacy and insurance company can help reduce the delays in the approval process.
What if my insurance denies the authorization?
Do not lose hope if your insurance company if your prior authorization is denied, it isn’t necessarily the final decision. You have the right to appeal the insurance company’s decision and your provider can also submit additional medical information or request an exception on your behalf. Your insurance could overturn the denial if they get more documentation showing if it is medically necessary.1,2
Become excellent in prior authorization, reimbursement & market access — enroll today
Why Isn’t My Medication Covered? Understanding Prior Authorizations
Demetra Koutmanis
Jul 31, 2026
4 minutes read
Sometimes your insurance company may not immediately cover a prescribed medication in these situations, in certain cases insurance companies may require a prior authorization before approving coverage. While this can delay access to a medication, there are several steps you can take to help complete the process and obtain coverage.
What is a prior authorization?
A prior authorization is a requirement by your insurance company that asks your provider to submit documentation before your medication can be covered. In other words, the purpose of this process is to confirm that your prescribed medication is medically necessary and appropriate for your condition.3
What to do when you receive a prior authorization requirement
Majority of the time it could be a minor issue as to why it is on hold before it is covered. To quicken up this process to get your prescription covered as soon as possible, the steps you can take is to:
Contact your provider’s office to make sure they are aware that your prescription has a prior authorization request
Confirm any additional medical records or documentation has been submitted to the insurance company
Follow up with your insurance company regarding any status of the request
Ask your local pharmacy whether if there are alternatives options available while waiting for approval
Clear communication between you, your provider, pharmacy and insurance company can help reduce the delays in the approval process.
What if my insurance denies the authorization?
Do not lose hope if your insurance company if your prior authorization is denied, it isn’t necessarily the final decision. You have the right to appeal the insurance company’s decision and your provider can also submit additional medical information or request an exception on your behalf. Your insurance could overturn the denial if they get more documentation showing if it is medically necessary.1,2
Become excellent in prior authorization, reimbursement & market access — enroll today
What if the authorization process takes too long?
Prior authorizations can take sometime to around days or weeks to complete. If your medication is needed right away, there are alternative options to help reduce the cost of your medication in the time being.
Pharmaceutical manufacturers offer patient assistance programs that can provide medication at a reduced cost or free of charge for eligible patients. (CMS 2025)
Prescription discount cards such as SingleCare may help lower your out of pocket expenses.4
These programs are designed to help you in special cases like this. If you have any questions you can contact your local pharmacist, your medication manufacturer’s patient assistance program, and your provider to look through your options and what works best for you! All of these resources may be able to assist you with affording your medication.
Prior authorizations are very common in the world of prescription coverage and are placed to help insurance companies determine whether a medication meets coverage requirements. Although it can cause delays, understanding the process and knowing where to seek assistance can help you navigate your coverage requirement more effectively. Working alongside your provider, pharmacy and insurance company overall will improve and quicken the process of access to your prescribed medications.
Prior authorizations can take sometime to around days or weeks to complete. If your medication is needed right away, there are alternative options to help reduce the cost of your medication in the time being.
Pharmaceutical manufacturers offer patient assistance programs that can provide medication at a reduced cost or free of charge for eligible patients. (CMS 2025)
Prescription discount cards such as SingleCare may help lower your out of pocket expenses.4
These programs are designed to help you in special cases like this. If you have any questions you can contact your local pharmacist, your medication manufacturer’s patient assistance program, and your provider to look through your options and what works best for you! All of these resources may be able to assist you with affording your medication.
Prior authorizations are very common in the world of prescription coverage and are placed to help insurance companies determine whether a medication meets coverage requirements. Although it can cause delays, understanding the process and knowing where to seek assistance can help you navigate your coverage requirement more effectively. Working alongside your provider, pharmacy and insurance company overall will improve and quicken the process of access to your prescribed medications.
