Molina Member Story

Disease Management Program For Sickle Cell Anemia

Meet Max

Max is a 29-year-old man from DuPage County who is in the disease management program for Sickle Cell Anemia. He was feeling more pain with his ongoing condition and needed pain medication to help her manage his health. The pharmacy did not have his pain medication due to supply shortage.

Getting Help

The provider contacted Molina’s disease management program and told Molina that they were unable to locate a pharmacy nearby that had the correct dosage as listed in Max’s prior authorization. They were able to find the medication in another dose. The provider was reluctant to create a second prior authorization request for Max which would override the original dosage for a temporary order. This would mean that a third prior authorization request would be needed to change the medication back to its original dose.

Now

Molina worked with the provider to explain the challenges and situation and advocated for Max to be able to get pain medication he needed. The pharmacy prior authorization requests were overridden. Max obtained the necessary medication to manage his sickle cell without returning to the hospital. Max continues to work with his case manager, provider, and care team to manage his condition. Max is thankful for Molina’s intervention to help him keep his medicine in his time of need.