Patients and Physicians Speak Out

I’m a Type 1 diabetic. Although there is no cure for this disease, it can be managed with appropriate prescription medications and an insulin pump. I currently have to obtain prior authorizations for three of my medications…every single year. This year alone I spent at least 40 hours on the phone in connection with my prior authorizations. My insurance company is demanding that I work for it one week per year (i.e., 40 hours) to fight for the medications that my doctor and I know are in my best interest.

I use Dexcom G6 constant glucose monitor for controlling post pancreatectomy diabetes (I have half a pancreas). Getting sensor and transmitter refills for the G6 system is challenged each time by the supplier, Medicare and my secondary insurance. If I use the DME supplier, they request prior authorization, and sometimes refuse to send supplies out of schedule when I need them before traveling overseas. They shave the timing so close that often supplies are delivered late. If I pay cash out-of-pocket to get supplies more timely from the pharmacy it may take about 3 months to get $1,258 reimbursement and 2 to 3 hours of phone calls and emails with the pharmacy, Medicare, and [my health insurance] to get 3-months’ supply of sensors. [Prior authorization] is an unnerving, time-consuming process to be endured for the sake of keeping my diabetes in control and not becoming an even greater burden to the insurance companies as a result of secondary complications that result when the disease is not controlled. This does not make sense.

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….

I work with a surgeon, treating breast cancer patients as the majority of our patients. I recently spent over 10 hours trying to get a patient's surgery authorized.