Insurer and Pharmacy Benefits Manager

There are also other resources for patients listed below:

• Drug Access Canada – provides information and links to alternative reimbursement means for unfunded drug costs, federal and provincial drug programs, and patient support programs for financial assistance in funding drugs, one of which may have been prescribed, prior authorization forms for private insurers and more.
• Is My Prescription Covered? is a free and interactive drug coverage finder from the Canadian Skin Patient Alliance. Patients can find out whether the medication prescribed is covered publicly or privately.
• Disease/Patient Group for the plan member’s diagnosis. Patients can find a list of some of these groups on the Resources page of this site. Many are knowledgeable on the drugs and treatments related to their specific disease. They may be able to refer the plan member to programs or services that may help cover drug costs or access treatment.

A plan member or patient who is communicating with a payer directly regarding prior authorization is unlikely to be familiar with the language used by those who work with prior authorization claims on a day-to-day basis. They may also be under significant emotional stress because of concerns regarding whether or not they will be able to access to their prescribed drugs, whether any cost to them will be affordable, time and income lost from work, or concerns about their long-term prognosis.

Providing plan members or patients with information in plain language and recommending that they reconnect with their physician, PSP, or DAN on next steps is an important part of communicating a claims denial.