Patients and Physicians Speak Out

I have been taking a medication that truly keeps me alive for 5 years. The last time I went to get my script I was told I could not have it unless my doctor got prior authorization for that medication. I, of course, was low on that medication, picking my script up with a few pills left in my bottle. If my doctor had not given me samples, (it took over two weeks for the authorization to go through) I would have possibly been dead. After five years they decide I need prior authorization….

Everything my pain management doctor had tried to get for me through a prior authorization has been denied. Now I’m just in constant pain and not able to do anything—much less enjoy the day. It’s ridiculous that all the sudden I have to have a prior authorization when they have covered it since 2006. It’s just outrageous what they are doing to us…I can’t afford to eat and purchase all the meds, so I have to make hard decisions.

I waited 6 days to get approved for Fentanyl patches for my cancer. My oncologist sent the prior authorization too. But these decisions are made on business days. So I had to suffer.

Prior authorization was very detrimental to a very close friend of mine. My friend has diabetes, severe hypertension, CKD-Stage 2, anemia and is legally blind secondary to diabetic retinopathy. In the spring of 2016 her primary care physician wrote a letter of prior authorization. He wanted to get her insurance company to approve a Catapres patch for treatment of her hypertension, because she could not tolerate the oral form of the medication without significant blood pressure fluctuations causing significant hypotension and hypertension. My friend was hospitalized that fall secondary to uncontrolled hypertension with edema and during that hospitalization they used the Catapres patch and her blood pressure finally stabilized. She has been using that medication ever since and now has well controlled blood pressure. It would seem the insurance company would have been wise to initially listen to the trained physician instead of paying for a hospitalization to come to the conclusion that my friend needed this medication.

I recently had a patient die due to needing a prior authorization for cefpodoxime axetil for a UTI.

Prior authorization has become a nightmare. I cannot tell you how many times I receive incorrect information (i.e. call three different people and get three different answers. This doesn't make me feel confident). As well as the fact when you do call as the patient is waiting for treatment the doctor and his technicians are waiting to do their job, you are on hold. You jump through hoops to finally get through to a live human being, only to give the same info you have given three or four times already. It backs up our entire day and flow. Not to mention the back of the insurance cards do not always give the pharmacy benefit manager so you are re-routed to maybe one (if lucky) or two different departments. As a healthcare worker for more than thirty-five years, I have only seen this process get more and more difficult to navigate. I feel it does not serve the patients nor the doctors and staff. We try to treat and care for our patients with the best intent with our hands tied.