I Couldn't Get The Pills Even Though They Had Them | Episode 506

A prescription can be sitting at the pharmacy, but still be out of reach. I’m Justin Alan Hayes, and I’m putting a spotlight on what happens when prior authorization, insurance approval, and pharmacy systems collide and the patient pays the price, sometimes with their mental health.

I walk you through a real timeline: the missing prior authorization notice that should have hit my prescriber immediately, the multi day delay that follows, and the moment CVS tells me my medication is “ready” for $372. After the form is finally approved, the price changes to $90, but the process somehow gets slower, not faster. Then comes the part that makes no sense: the system acts like the medication needs to be reordered even though it was already there when the cash price applied. That’s not just frustrating, it’s dangerous when the medication is meant to be taken daily and anxiety is already high.

We also dig into the practical issues people run into every day: generic vs name brand choices, confusing automated phone updates, inventory and billing mismatches, and the way patients are forced to be the middleman between insurance companies and pharmacies. I share why this kind of administrative red tape can push people who are already struggling to a breaking point, and why healthcare accountability has to include the systems and policies that create these delays.

If you’ve ever battled prescription coverage, prior authorization, or pharmacy delays, you’re not alone. Subscribe, share this with someone who needs it, and leave a review so more people can find Voices for Voices and feel supported.

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Chapter Markers

• 0:00 Welcome And The Mission
• 1:49 The Prior Authorization Breakdown
• 8:20 CVS Pricing Shock And Confusion
• 14:40 Out Of Stock Vs Reality
• 20:14 When Delays Put Lives At Risk
• 26:00 Accountability And A Better System
• 29:23 Final Thoughts And How To Help

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Transcript

Welcome And The Mission

Voices for Voices, Justin Alan Hayes 0:01

Hi everyone, it's Justin here with Voices for Voices. Thank you very much for joining us. If you're watching or listening here in the United States or across the world, we're grateful and humbled to have you with us. If you can give us a big thumbs up, like, follow, subscribe, share, repost, uh, follow our social media, all free things to do that'd greatly help us uh impact and help uh and reach the individuals that uh could could benefit from our shows, the content, the experiences, uh, all that. And if you're able to uh reach out to the contacts in your phone and let them know about the Voices for Voices organization, which is built on the foundation of mental health, mental illness, trauma recovery, all the things related, uh, and have them check out the show because uh it's a very popular show, and we're finding out really day by day as each day goes by, uh, how popular the show really is. So thank you for joining us. We have a huge goal. We want to help uh reach and help three billion people at least over the course of my lifetime and beyond, and we're well on our way, thanks to you. So thank you for all the love and support. We feel that, and we're sending that back to you. So we're

The Prior Authorization Breakdown

Voices for Voices, Justin Alan Hayes 1:49

gonna jump into uh our topic for our show. Uh, an earlier episode, uh, we we focused on uh United Healthcare Shurist and how they were negatively impacting my ability to get one of my mental illness uh prescriptions uh because of a prior authorization form that needed filled out by my prescriber, my psychiatrist, practicing nurse. Uh and so we talked heavily about that, where we have strong feelings that if my psychiatrist, when she put in the script, put in the prescription order, uh it I believe that she should have been made aware by insurance, right? You know, they always ask you for insurance, you go into office, and has insurance changed, uh okay, if it's changed, so do you have your new card? And so all that information is stored in a computer. So why can't another, you know, this prior authorization form, why why can't there be a message where okay, I'm sending a prescription in for one of my patients, hit the send button or whatever button, the return button, the send button, whatever makes it that message go to the pharmacy, uh, whether it's local or mail away. Uh the prescriber, psychiatrist, uh should get if there is a prior authorization form needed for the pharmacy to actually fill the prescription. Um there should be an automatic, you know, hey, you need to fill out this prior authorization form for for this prescription to go to the pharmacy. So that's on the insurance side of things. Uh so a day has passed. We were trying so hard to get this episode shot uh the same same day yesterday, as when we were talking about the United Healthcare assurance and how they were negatively and had negatively impacted uh me getting the prescription that I needed and that I need. So that was one day without so that prior day. Uh so we're we're here on a Wednesday right now, film me this. So Monday didn't I didn't have the prescription I needed. So comes Tuesday, I get a message from my prescriber saying, filled out the form, it's approved by insurance. Okay, so again, this is something that could have been done four days ago if my prescriber knew that she needed to fill this form out. So to get us up to speed, filled out the form, insurance approved it, finally, but as a psychiatrist, she had to she had to go and do the a lot of the legwork, the find the form to all that stuff, and it takes time, okay. Then to find out, and we talked about this as well, that CVS was telling me, oh, you're in, you know, because we didn't have this formed, it was signed, filled out. I was told, oh, well, your insurance doesn't cover this, so if you want it, uh you're gonna have to pay $372. $372. $372 for the prescription. Okay. So I get notified via text, prescription's ready, ready for pickup. And then I'm I call in and I'm made aware that oh you can get it, you know, for that $372 figure. Meaning that the prescription's actually at the prescription is actually at the pharmacy where I transact and do business. So it's there. It's physically there. If I would have went Monday and paid the three hundred and seventy-two dollars, I would have got the prescription. Physically it's there at CVS. The very CVS that I pick up my other prescriptions. So that's in the background.

CVS Pricing Shock And Confusion

Voices for Voices, Justin Alan Hayes 8:20

Then yesterday morning I got a message from my prescriber saying, filled out the form, the insurance approved it. It should be available at the pharmacy. Okay. So I call, right? The automated number and all that, and we and the automated number isn't updated with this update for the nine, you know, instead of three hundred and seventy-two dollars that now it's covered under insurance because you know, this form that should have been filled out last week, which the insurance company did not let my prescriber know that it needed to be filled out. So could have bought, I could have got it, bought it for $372, which meant that the the actual pills or capsules or whatever, again, they're physically at that CVS location. So I call again the automated number, and it still says, Oh, you can get this. It's ready for pickup. Estimated cost $372. So I leave a voicemail and say, hey, you know, my prescriber filled out the form, insurance approved it, finally. See, I'm not leaving the I'm not letting insurance off, not letting United Healthcare Shurest off the hook. Because they're the reason it took the time to get to where four days had elapsed. But for this specific show, talking about the ridiculousness, and I don't know if it's just CVS, it might be Walgreens as well. I don't know. So as I said, I called after I was made aware that the form and all that was everything was good. So $90. I'm not happy about $90. I think $90 is ridiculous. Not to mention, I don't get name brand. Very few of us get the name brand because it's so expensive. And there is an alternative, like a generic. And all my other prescriptions are all generics. And there's a generic version of this. So I don't I don't know why CVS didn't just, you know, after the authorization form and you know, all that hassle after all that happened. I don't know why CVS didn't fill the generic. Because that's what my insurance was telling me. They said, if you can't get this particular medication, here's an all the alternative, which basically means this is this is the generic, and so it's gonna be less cost. So less than $90 and what? That's water under the bridge. I'll deal with that next month. Because it's not gonna it's not gonna help now because I'm working through, you know, the the the these issues. So I call CVS, they say 372, pharmacist calls me back, says, okay, I just I looked into your file, and yep, you do have the form. We can you know go forward and and your insurance will cover it, and it'll be $90. Again, I'm not happy about that. $90 for 30 days uplight what $3 a day for one. I I mean it's just ridiculous ridiculous. So, President Trump, I hope you're hearing this, you're watching this. Hope your team's hearing and watching. It's it's not right. So the pharmacist calls back, says, Yep, we're good, $90. Uh, it'll be good, it'll be ready tomorrow. Okay, this this isn't like the end of the day. This is you know, the middle of the day. And I was like, what do you mean? It's it'll be available tomorrow. I called not more than you know, a couple hours earlier, and and the automated system said, Yeah, I could come in and paid it a three set $372 for the prescription, that the prescription's there, physically there. So all they literally need to do is to transfer and say, okay, now we have this under insurance. We have the physical thing, things, the medication for 30 or 31 days. And now he's telling me, oh, we gotta wait till tomorrow. Like, why do I gotta wait till tomorrow? I could come in and pick it up yesterday or to earlier today, before

Out Of Stock Vs Reality

Voices for Voices, Justin Alan Hayes 14:40

you know the form, the prior authorization form got filled out. And I get a message says, out of stock. This prescription's not typically stocked in the pharmacy and was ordered by you. Okay. As a reminder, please reorder two business days ahead of time. Well, we did do that, so that's where the insurance nighted healthcare assurance of insurance would have sent a message right away to my prescriber last week. So we did everything we're supposed to do. We we got it sent in in enough time that I was I wasn't that when I ran out, I was gonna have the new prescription, you know, that kind of get pick it up from there. And I wouldn't have to miss any days. And so a presc the prescription that is there, I have no doubt that that's gonna be what I'm gonna get today. And so there's this whole thing about well we gotta fill it. So this is like like a new a new order. Well, it's not really a new order, it's the same order. Now it's covered under the insurance. So CVS, this is bullshit. Straight up bullshit. You and United Healthcare and any other entity that pulls this shit on average, everyday citizens, human beings. You know, it takes a lot for me to get fired up. When I get fired up, I get fired up, I get I get angry, I get pissed. So I went two days, I've gone two days without a medications on supposed to be taken daily. Because United Healthcare sure is fucked up. They fucked up because they didn't again, they didn't get that prior authorization form communication to my prescriber, so my prescriber didn't know that it needed filled out. CVS should have filled the fucking generic and not the name brand, because I don't want the name brand for this very reason because it's so expensive. And then for the days to go by, and then I find out, oh yeah, you can come get it for $372 days in a row. And then on that second day, uh yeah, well, I got, you know, not you got the form done and it's under insurance, and so um, yeah, we'll have it ready for you tomorrow. The fuck do you mean you'll have it ready for me tomorrow? You have the damn thing in the bag that if I come to the drive-thru and pay the $372, I'm very well gonna get that prescription. So there's gotta be a fix. There's gotta be something. CVS in Hudson, Ohio. Corporate CVS. I don't know where corporate CVS is, because that's where all the decisions and and all that get made. Get your ass in gear. You're fucking around with people's lives. Luckily, I was able to manage getting through the last two days with a very important medication. I don't want to take medication, that's the other part. I don't want to. Which is a battle every single fucking day of the year.

When Delays Put Lives At Risk

Voices for Voices, Justin Alan Hayes 20:14

So I'm bringing this up because what about the people who go through this and don't make the call? And they're just like, you know what, fuck it. Like, life ain't worth it. That's what this is for. This is to help those individuals and help other individuals who are reaching out and want to reach out, and it's taken so much. Maybe we've been an inspiration to them to say, you know what? Like, I don't want to go to therapy, I don't want to be seen by a psychiatrist, but maybe I I need to. This is the type of shit that happens when somebody does decide that they're going to do that. That they made it so far where they're like, alright, I I've got a I've got a I got two decisions. Or I got I got one decision to make, I got two options. Am I gonna live or am I gonna die? I mean that that's straight up what it is. Now people go, oh, now you're being you're being dramatic, Justin. Oh no, I'm not. This is administrative bullshit. Both on United Healthcare Assurers and on CVS. Because I'm gonna get that same fucking prescription. They're literally just gonna. Unstaple, you know, the date that it was ordered and all that, and they're gonna re-staple when it was filled, which is gonna be today. So when I get told by the pharmacist that, oh, we gotta call, we gotta order that shit because we don't carry name brand like that. So we gotta order it. I'm like, you already have it there. He goes, Yeah, but I I I don't understand the automated message. You know, my computer is showing me that we don't have it in stock. The fuck are you talking about? I was able to come in again. $372, you would have gladly taken my money. And so this shit needs to end, CVS. This shit needs to end, United Healthcare Assurance. You need to get down to helping people and make things as easy as possible all the way from the prescriber down to the patient. Again, I don't like taking medication. I don't want to. I'm I don't want to. Haven't wanted to from day one, but I swallowed my pride. I decided, you know what? That's something I gotta do. I gotta do it. This is gonna help me along with my therapy and and coping mechanisms and and all those things together. Now, if I didn't have those other things, I don't know what would have happened. I don't know if I would have been able to make it through the day. Because my anxiety was through the roof both both days and really now, because I don't have it right this minute, and I haven't I haven't, I just checked my phone, I don't have a text saying it's ready. So for someone literally in the pharmacy, again, to take that prescription out of that bag that was gonna be for the $372 and putting it in a new bag for $90, the fuck out of here. You're messing with people's lives. So CVS, you need to be held accountable. And any and other any and all other pharmacies, other healthcare companies that are standing in the way. If I want to be like an active participant in my recover my mental health recovery, which there's not gonna be one day where I'm healed, like it's a constant battle. So quite literally, United Healthcare Assurance and CVS are playing with people's lives. And I would think for the amount of money that the business makes, and that the people at the top, the executives, what's the reason why? I want to know. Tell me, tell my viewers, tell my listeners why

Accountability And A Better System

Voices for Voices, Justin Alan Hayes 26:00

this prior authorization form is not like an automatic, automated part of submitting a particular prescription. It's not just mine, there's probably a bunch others, and I I talked about in the earlier episode about my dad. He was going for his cancer treatment, chemo, and they knew right there and then if the doctor said we're okay, we're gonna switch, we're gonna add the this particular medication with the chemo and all that. They knew right then and there we gotta get prior authorization. So I get it. I'm not talking about me having cancer, but somewhere along the way. Is it because cancer is more lucrative and so cancer treatment's more lucrative? That's what I meant. I I don't know, but it's complete and utter bullshit to have anybody have to wait and again, what if somebody there's a lot of somebody's out there that are hurting, they're struggling, they want help. They don't know what to do. They're being told it's taking three months to get in to see the therapist or a psychiatrist. And then to have this happen. CVS, get your shit together. United Healthcare assure us, get your shit together. That's why I'm putting both of you on blast. You can get upset all you want. This is real life that I'm talking about. And that's what we talk about on our show. Our shows over 500, by the way. So I hope this lights a fire under somebody to do something to help humanity, to make things easier for prescribers. To stop the bullshit about, oh well, we have it and we have this particular prescription in stock for this, but oh, now we gotta, you know, we're redoing it. So now the computer's showing us that there's zero in stock, yet I'm looking at it with my own eyes. I'm seeing it. It's called administrative bullshit, administrative red tape, purple tape, whatever. That shit needs fixed. That's gonna help a lot of people.

Final Thoughts And How To Help

Voices for Voices, Justin Alan Hayes 29:23

Thank you so much for watching, listening to this episode of show. Give us a big thumbs up, like, follow, subscribe, share, repost, follow our socials, especially our Instagram and Facebook, and reach out to 25, 50, 100, all the contacts in our phone. Get them aboard our movement to help and reach at least 3 billion people over the course of my lifetime and beyond. Thank you very much. We love you. Thank you for the support and the love. We feel that, and send it right back to you. So until next time, Justin Alan Hayes here, Voices for Voices, TV Show and Podcast. Have a wonderful day. Bye bye for now.