Patients and Physicians Speak Out

I have no admin back-up. All prior authorizations are done by me. As a psychiatrist, I book my schedule as tightly as possible, so these extra phone calls, being on "perma-hold" for 10-25 minutes, takes a big bite out of my time. Not to mention that they often are on the mainland, and there is a 2-3 hour difference in time zones between Hawaii and California. Not to mention the 5-6 hour difference to the East Coast, so it's hard to do this at the end of the day for me. A colossal waste of my time, a never-ending source of frustration, and frankly, another thing to push me towards retirement, and I know that there is still a shortage of private psychiatrists in my state.

PA affects me absolutely f***inglutely. I'm an internist in a rural north GA town. It absolutely INFURIATES ME when I have to call someone who doesn't know the difference between a jaw and sinuses yet has the power to deny a patient a study or treatment. They are so completely unaware of anything medical and I had to go through at least 10 years of training before I could touch a patient.

I have one dedicated staff member who has primary responsibility for all prior authorizations. From an 8-hour work day she dedicates 6 of them to prior authorizations. This is uncompensated care. Written prior authorizations most recently have increased in the number of pages that have to be filled out. We actually have prior authorizations pending with a total of 119 pages. Valuable time is spent away from patient care. What is most obnoxious is that there is no medical rationale in demanding the prior authorization…Frequently, there is no point of contact that can make a medical decision on the other end of the phone…Standard of care is affected by this entire egregious process…I could go on, but at this point it feels like a no-win situation where you are forced to submit to the demands of the pharmacy benefit manager.

I have seen patients not able to get their Depo-Provera shots in time due to need for prior authorization and patients that have to wait for PA in order to schedule their required imaging, causing at least a 1-2-week delay. This is UNNECESSARY and frustrating when you think that the patient shouldn’t need to wait that long (seeing how if they were in the ER, they wouldn't have to wait, but rather you are going to punish the patient for going to their PCP instead?? BACKWARDS!!!). These are just the 2 examples from my last week in practice...and do not get me started on the amount of time (easily hours!) my staff spends EVERY week filling out prior authorization forms for medications, some of which are merely continuations of therapy medications for patients.

I am a pediatrician, and I find prior authorizations to be a huge burden to my office's productivity. Additionally, I have experienced significant delays getting my patients the treatments that they need, including life-saving treatments such as epinephrine autoinjectors for anaphylaxis and inhalers for asthma. I also struggle getting medications approved for ADHD, acne, and even some critically important psychiatric medications, leaving patients with severe depression and hallucinations untreated with delays ranging from days to weeks.

I tried to obtain authorization for Lupron-Depot therapy, but was denied with the excuse that I had not exhausted other treatment modalities such as Danazol. Do they really expect me to put this vulnerable patient, who is already both physically and mentally devastated by her endometriosis, on this horrendous medication? Both the patient and her mother are now literally begging me to do a hysterectomy and bilateral salpingoophorectomy on this 18-year old to relieve her of the torture she goes through on a monthly basis.