Member Situation
An Arlo member contacted the advocacy team after being unable to fill a prescribed migraine medication at her pharmacy.
The prescription required prior authorization, and although her provider believed it had already been submitted, the medication continued to be denied.
The situation became
increasingly stressful for the member. Her health plan coverage was scheduled to end at the end
of the month, she was traveling,
and she was concerned about
both her health and the potential cost of the medication if the
issue was not resolved before coverage terminated.
How Our Advocates Helped
Arlo advocates immediately began coordinating with both the provider and the pharmacy benefit manager, SmithRx. While prior authorizations typically take 7–10 business days, the team discovered that the provider had not submitted required clinical information needed for the authorization review.
Complicating matters further, the provider had mistakenly sent a second authorization request to Cigna and was difficult to reach, making it challenging to identify the root cause of the delay.
Arlo advocates persistently followed up with the provider until the issue was identified and corrected. Once the authorization request was properly submitted, the advocacy team contacted SmithRx and requested an expedited review given the member’s impending coverage termination.
Member Outcome
Within 24 hours, the medication was approved. Arlo advocates then contacted the member’s pharmacy to confirm that the authorization had been received and that the prescription was being filled immediately.
The member was able to pick up her medication the following day—before her coverage ended—ensuring there was no disruption in treatment.
Throughout the process, Arlo advocates managed communication with the provider, pharmacy, and PBM while keeping the member informed every step of the way.
By the end of the interaction, the member expressed deep appreciation for the support she received and rated the experience 5 stars, noting how much she valued the close guidance throughout the process.
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