APRIL 22, 2015 – Remember the ye olde days when a physician evaluated a patient, made a treatment plan, and then prescribed a medication if needed?
What happened after the patient got the prescription? They went to the pharmacy and filled it, that’s exactly what they did.
What happens now?
- Pharmacy has to check insurance.
- Insurance sends back paperwork that a “prior authorization” is required to cover the prescription.
- The pharmacy communicates with the doctor that the prior authorization needs to be completed.
- The physician completes the prior authorization, which requires a series of phone calls and faxes that can take easily up to 15-30 minutes.
- The physician calls the pharmacy with the authorization number.
- The pharmacy fills the medication.
- The patient picks it up.
Simple right? This doesn’t always work. Sometimes the insurance denies the medication, the dosage, the number of tablets prescribed, based on an algorithm.
As even generic medications are even commonly being required for prior authorization, I say “Stop the madness”.
My patients are unique. When I do a prior authorization in front of a patient, they are surprised at the amount of time it takes, and the denials. They wonder why they pay for insurance only to have to the doctor jump all these additional hoops.
My prior authorization is the prescription I wrote.
And no more.