Patients and Physicians Speak Out

We treat severe asthmatics, Primary Immune Immunodeficiency and a rare genetic disorder, HAE. All of the medications for these patients require hours of prior authorization work. I have a full time physician assistant who spends 40-50% of her time addressing these. Beyond these requests we now are required to spend time preapproving commonly prescribed and inexpensive medications for almost every patient we see. We are also seeing prior authorization requests on common procedures which does not allow us to complete needed treatment at the time of the visit. This nonsensical waste of time has got to stop!

So after 20 years of practice, Board Certified, MOC'd, actually caring for the patient, deciding on best care alternatives, why would ANYone interfere with that? You deny my request, fine, you have NOW taken over the care and treatment of the patient, with all the responsibilities of that care. How can you give us all the accountability, but no authority? This must change.

It is time consuming, frustrating for doctor and patient, and of no clinical benefit.

I work in a headache clinic. Most of our treatments, at this time, are "off-label." When I prescribe a medication that is denied, the pharmacist tells the patient that I just have to do a prior auth and they can get it. I (and my MA who spends 50% of her time doing this) completes the prior auth, however, the prior auth requires a stratified treatment based on the medication's FDA-approved indication. I explain and even include studies to show the potential benefit for headaches. The prior auth is denied and the information given to the patient, either by the pharmacist or by the patient's insurance rep, is that a) I didn't do the prior auth correctly, or b) it was not the right medication for that patient. Both statements seriously erode the patient's trust in my knowledge and ability to help them.

I have one employee entirely devoted to prior authorizations appeals and setting up peer-to-peer appointments.  It is one of the worst things to occur to the non-surgical practice of medicine.

Did a nephrectomy on a patient and sent him a prescription for pain medication—same ones he was getting in the hospital—and the pharmacy would not fill without a prior authorization from me. Patient had to go to the ER to get some pills. How much do you think that saved the insurance company?