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Al-Agba, MD: Can Insurers Be Guilty of Malpractice?

Sometimes, says Niran S. Al-Agba, MD

  • By Niran S. Al-Agba, MD

In July 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topamax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication.

But in July 2009, she turned 19. And when shortly after her birthday, her family went to pick up the medicine the pharmacist told them they’d either have to shell out $399.99 to purchase Topamax out-of-pocket or obtain a so-called “prior authorization” in order to have the prescription filled.



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