3 More Tips for Getting Your Specialty Medication on Time

In February, I attended the National Psoriasis Foundation's Volunteer Summit in Nashville, Tennessee. During a small group session, Jason from the National Psoriasis Foundation asked about the greatest challenge that people with psoriasis face. I immediately volunteered my answer.

My ongoing challenge is insurance approval for specialty medications. The week before the summit, I had spent hours on the phone trying to get a refill for my eczema biologic, Adbry (tralokinumab). I felt exasperated and frustrated by the ordeal.

When I mentioned my insurance frustrations, others in my small group jumped in to relay their negative experiences. If you’ve crashed into barriers while trying to fill your biologic or other expensive specialty medication prescriptions, you are not alone.

I thought I had a foolproof approach to receiving my specialty medications — four years ago, I shared my top tips. This recent incident showed me that I still have much more to learn when it comes to advocating for myself. I hope that my recent experience will help you get your medication on time.

1. Confirm the Pharmacy Order

My biologic is eligible for refill about two weeks before my next dose. I signed up for text reminders from the pharmacy so I know when that time comes. It’s easy to ignore the alert in busy moments, but I’ve learned to pay attention to it.

This last time, I ordered my prescription refill through the online portal soon after receiving the notification. The confirmation email in my inbox gave me a false sense of assurance. The day before I expected the delivery of my biologic, I received a message to call the specialty pharmacy.

The insurance provider required a second prior authorization before releasing the funds to cover the cost of the medication. For the next week, I contacted the specialty pharmacy, insurance provider, and my doctor’s office to clarify what was needed.

The doctor’s office told me twice that they didn’t feel that they needed to send another prior authorization. The pharmacy disagreed, saying the insurance wouldn’t release the funds to cover the prescription without it. All the back and forth wasted time and delayed my dose.

Lesson learned: While I was proactive in ordering my refill early, I didn’t contact the specialty pharmacy until the day before I needed my medication. Now if I order a refill online, I call the same day to make sure that the prescription claim raised no issues with the insurance coverage.

2. Pinpoint the Issue (if There Is One)

Today I followed my own advice and called the specialty pharmacy to confirm that everything is on track with my next Skyrizi (risankizumab) refill, which I take to treat my psoriasis. The two-minute phone call provided much peace of mind after what happened with Adbry last time.

It’s not always easy to pinpoint the issue when an insurance claim triggers the need for authorizations. My hope is that back-end insurance issues get worked out without my involvement.

Stepping in, though, helps me get my medication sooner when a problem arises.

One time the pharmacy couldn’t run a Skyrizi claim because of the number of days between doses. I take Skyrizi every eight weeks, which is 56 days, but the system couldn’t process that. When I asked the pharmacy to enter 60 days, or a two-month supply, the order went through their system. Later, the pharmacy and doctor communicated and corrected the mistake.

This last time for Adbry it came down to a misunderstanding about the dose. Adbry comes in a box with two injections, each of which have 2 milliliters of medication. The doctor requested that I have two injections per month. Insurance read “two” as the medication amount, 2 milliliters, which is only one injection.

That “two” versus “four” on the prescription cost me hours of phone calls to figure out, but once we did, the order moved forward.

3. Don’t Panic if Your Dose Is Late

Because of the delay, the prescription I had ordered two weeks early would now be at least a week late. With the successful resolution of the insurance issue, I called the specialty pharmacy to see if the order could be sent as soon as possible. The clerk asked me to hold for a few minutes, then delivered the best news I could imagine: The medication could be delivered overnight.

I then asked if I could still take the dose a week late and was told to contact my dermatologist. I immediately logged into the patient portal to message my doctor. I didn’t expect a response, as it was the end of the workday on a Friday, but I must have caught her just before leaving the clinic. She confirmed that I could inject the medication over the weekend, then go back to my every-other-week injection schedule.

I had felt panicked at first with the delays that led to a missed dose, but it turns out I didn’t need to, as I now had medication coming the next day with a workable plan going forward.

Anxiety surrounding late-arriving prescriptions and doses is more than understandable. Looking back, I could have been steadier on my feet as I made my way through the insurance maze.

I still feel that the healthcare system is stretched and broken in many ways, including getting specialty medications like biologics on time and covered. Yet when I advocate for my health needs, I’m resisting the forces that want me to quit and give up. Life is too precious to accept less than what is best for me.