What if the PA is Denied?

While ideally a PA would be approved on the first submission, there's a reason peer-to-peer reviews and the ilk exist! A PA may be denied by the insurance if the reviewer deems so, but in those instances you may often request a "peer-to-peer review." In this, a medical professional (e.g. oftentimes the prescriber) responsible for the therapy requested speaks directly with a medical professional within the insurance to debate their justification of denial of services. While some insurances may require it to be the prescribing physician who calls and speaks with them directly, our pharmacist will work directly with the physician prior to that to discuss and prepare all rationale necessary to advocate for the patient's treatment.