Kansas Family Battles Insurance Denial for Life-Saving Medication

By Consumers for Quality Care, on November 27, 2024

A Kansas family is fighting their insurance company’s denial of a life-saving drug. According to KWCH, their struggle is a microcosm of a larger issue: how prior authorization inhibits access to care.

Although prior authorization is meant to be a cost-control measure, patient advocates suspect that some insurers are exploiting it to deny patients care.

Christina Novak and her family are battling with Blue Cross Blue Shield of Kansas (BCBSKS) to secure approval for the medication Tolvaptan, which is critical for managing her condition, hyponatremia, which causes low sodium levels. The medication was previously approved by the insurance company, but now without coverage, Novak is forced to pay more than $1,000 each month out-of-pocket.

The medication helps her mother stave off medical interventions, says Novak’s daughter, Christa Gann, who is also a nurse. Unfortunately, for Novak, a visit to the emergency room is the only way to acquire her medication. “I feel ridiculous that I’m taking her to an emergency room to receive a dose of a medication that’s not a narcotic and that’s not insulin,” said Gann. “It is simply just a special medication that prevents her sodium from dropping.”

Novak’s doctor has also appealed to BCBSKS, emphasizing in a letter that Tolvaptan has been proven safe for long-term use with proper monitoring, as well as drastically reduced her hospitalizations and health care costs.

In the meantime, the family has resorted to driving out of state to purchase the 30-day supply of medication for over $1,900, but they acknowledge this is not sustainable. Gann fears the clock is ticking on their ability to afford the drug as they seek alternative solutions.

CQC urges both lawmakers and providers to eliminate needless, burdensome processes that prevent consumers from receiving the medical care they need.