A Prescription of Perseverance
Helping Henry get the medication he needs.
Henry needed growth hormone therapy medications as soon as possible. But after he received a denial letter for his medications the Care Management team reached out to Henry's legal guardian about the Care Management program.
Henry had been ordered Norditropin which was a non-formulary medication. The CareSource care team got right to work, calling the Endocrinologist's office to request a prior authorization of Omnitrope, which had been suggested in the denial letter and by the provider, as an alternative. The office then submitted the prior authorization for the new medication, but because criteria for approval was clinical information of positive bone growth while being administered this medication in the past and currently, the prior authorization was denied.
Both Henry's legal guardian and the care team were persistent, calling the specialist's office frequently, encouraging the provider to submit a new prior authorization submission for approval, with the needed clinical information. Action was taken, and the office placed an urgent request for the submission. Approval for the medication was granted the next day. After that the care team worked with a specialty pharmacy to expedite the medication to prevent Henry from running out of the medication.
In the end, Henry received the needed medication with the help of his Care Management team.
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