Resources and News

New Year’s Day marks a challenging time for health care providers as it brings a flood of requests to renew prior authorizations. This bureaucratic tactic from insurers tests our commitment to the treatments we select for our patients.

Prior authorizations and poorly designed EHRs are top frustrations for physicians. Dr. Jack Resneck, a dermatologist and former AMA board chair, notes that their expanding scope and time demands negatively impact patient care.

Interview with Jack Resneck, MD, author of Refocusing Medication Prior Authorization on Its Intended Purpose

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While prior authorization requirements can serve valid purposes, a concerning issue arises when plans change their formularies due to new kickback or discount arrangements, a practice that seems to occur annually.

As an active 48-year-old athlete, I don’t fit the mold of your typical cardiac patient. I exercise 6-7 days per week and have normal weight and blood pressure. But when I started having chest pains in November, I knew something was wrong.

My cardiologist, Dr. Kenneth Mendel, ran a number of tests. My EKG came back fine. My stress test replicated my symptoms but did not show the changes usually seen when blood flow to the heart is restricted.

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We know how important it is to have insurance so that we can get health care. As a physician, parent and patient, I cannot overemphasize that having insurance is not enough.

Colin J. Haller was smart, funny, ambitious and athletic. And he was just 25 when he was diagnosed with metastatic melanoma.

The Maryland native had already launched a successful internet marketing business. An outstanding student, he was applying to medical schools to pursue his dream of a career in medicine when he got that terrible news. His treatment plan called for scans every three months to assess the progress of this deadliest form of skin cancer.

For Bridgett Snelten, changing her health insurance meant enduring wild blood sugar swings, bouts of vomiting and weight gain.

In July 2009, Massachusetts teenager Yarushka Rivera's family went to Walgreens to pick up Topamax, her anti-seizure medication. However, after she turned 19 in June, they were informed they would need a prior authorization or face high costs for the medication.

Kate Weissman sits at the edge of the patient table. Her oncologist goes over her medical records and says her most recent scans show no recurrence of cervical cancer.

While utilization management in general is a pain point for everyone, it’s a necessary evil in the United States, where we spend 18% of our gross domestic product on healthcare, explained Debra Patt, MD, MPH, MBA, vice president, policy and strategy, Texas Oncology; medical director, analytics, McKesson Specialty Health, during a session at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, Illinois.

Dr. Michael Kirsch recently ordered a CT scan colonography for a patient with gastrointestinal issues who refused a colonoscopy and lacked insurance. The insurance company denied the scan, and he felt the peer discussion focused more on protocols than patient care.