Patient Advocacy: Navigating Insurance Prior Authorisation
You are shadowing a primary care physician when a patient with Type 2 diabetes is told that her insurer has denied prior authorisation for a GLP-1 receptor agonist that her doctor considers the most appropriate medication for her comorbidities. The denial letter states the patient must 'fail' two cheaper alternatives first. The physician is frustrated but says she does not have time to file an appeal. As a future physician, how do you think about this scenario in terms of patient advocacy, and what would you do in this moment as a pre-medical student?
Likely follow-up · What is a step therapy or 'fail first' policy, and why do many physician organisations argue it harms patients?